Shape of the right ventricular outflow Doppler envelope and severity of pulmonary hypertension

Abstract

It is now well known that timing of right ventricular outflow tract (RVOT) spectral Doppler signals change with increasing pulmonary hypertension severity. We devised a study to determine whether visual assessment of these RVOT Doppler signals can be useful identifying the severity of pulmonary hypertension. Visual inspection of pulsed RVOT Doppler signals from 120 consecutive patients (mean age of 55 ± 12, range 29-89 years; 45 males); with a mean pulmonary artery systolic pressure (PASP) of 59 ± 29, (ranging from 18 to 150 mmHg), of whom 78 patients had PASP >40 mmHg, was performed and correlated with standard echo Doppler variables of right ventricular performance. Visual inspection of RVOT spectral Doppler signals from the 120 patients showed four dynamic patterns and on a stepwise multiple regression analysis, PASP was the only echocardiographic variable that correlated with these different types of RVOT spectral Doppler signals. Furthermore, receiver operator curve analysis of these RVOT spectral Doppler signals correlated well with different ranges of PASP. Visual assessment of RVOT spectral signals demonstrates the presence of four dynamic patterns, independent of the aetiology of the pulmonary hypertension, that not only correlate with the severity of pulmonary hypertension, but also are useful in identifying a range of PASP with great accuracy that minimizes subjective interpretation. These simple visual assessments of RVOT Doppler signals can be done routinely when evaluating patients with pulmonary hypertension without the need of additional sophisticated equipment.