A novel echocardiography formula for calculating predicted pulmonary vascular resistance in patients with mitral stenosis
Background: Pulmonary vascular resistance (PVR) plays an important role in the natural history, prognosis, and outcome after valve intervention in patients with mitral stenosis (MS). The existing formula to estimate PVR by means of echocardiography is not readily applicable in the MS patient subset because it does not specifically calculate the risk of PVR in MS. The aim of this study was to find a new echocardiography formula to estimate PVR in MS.
Methods: This diagnostic study was conducted in 2 stages. In the first stage, 58 consecutive subjects with MS were studied to find some model formulas for estimating PVR by multiple regression. Eight echo parameters were analyzed to seek their correlation with the invasive PVR value as a gold standard. The formula that had the best correlation and was easiest to use would be selected. In the second stage, those model formulas were validated by applying them to a further 34 consecutive MS subjects.
Results: Four formulas which gave a discriminator coefficient of r2 0.62–0.68 were derived. The best model formula was proposed for further application. The new selected formula PVR=-7.465+3.566 TRvmax –(0.23 TVs’)+6.799 (RV-MPI) showed good correlation (r=0.71, p<0.001) to the invasive PVR value, with good reliability. TRvmax is maximal velocity of tricuspid regurgitation, TVs’ is systolic velocity of tricuspid annulus, and RV-MPI is right ventricle index myocardial performance. ROC curve showed that the cut off point 7.2 has good sensitivity and specificity (90% and 88%, respectively) to predict PVR 7 WU.
Conclusion: This study has shown that a novel echocardiography formula can estimate PVR with good correlation and reliability in subjects with mitral stenosis.
Carapetis JR. Rheumatic heart disease in Asia. Circulation. 2008;118(25):2748–53. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.774307
who.int [Internet]. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation 2001. WHO Technical Report Series. [update 2004, cited 2012]. Available from http://www.who.int/cardiovascular_diseases/resources/en/cvd_trs923.pdf
Carapetis JR. Rheumatic heart disease in developing countries. N Eng J Med. 2007;357:439–41. http://dx.doi.org/10.1056/NEJMp078039
Otto C, Bonow R. Valvular heart disease. In: Braunwald E, Libby P, Bonow R, Mann D, Zipes D, editors. Braunwald's heart disease: a textbook of cardiovascular medicine. 8th ed. Philadelphia: Saunders Elsevier; 2008. p. 1646.
Harikrishnan S, Chandrasekharan K. Pulmonary hypertension in rheumatic heart disease. PVRI Review. 2009;1:13–9. http://dx.doi.org/10.4103/0974-6013.44874
Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon D, Freed MD, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523–661. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.190748
Kern M, Deligonul U, Donohue T, Caracciolo E, Feldman T. Hemodynamic data. In: Kern MJ, editor. The cardiac catheterization handbook. 2nd ed. Missouri: Mosby; 1995. p. 108–207.
Abbas AE, Fortuin FD, Schiller NB, Appleton CP, Moreno CA, Lester SJ. A simple method for noninvasive estimation of pulmonary vascular resistance. J Am Coll Cardiol. 2003;41(6):1021–7. http://dx.doi.org/10.1016/S0735-1097(02)02973-X
Haddad F, Zamanian R, Beraud AS, Schnittger I, Feinstein J, Peterson T, et al. A novel non-invasive method of estimating pulmonary vascular resistance in patients with pulmonary arterial hypertension. J Am Soc Echocardiogr. 2009;22(5):523–9. http://dx.doi.org/10.1016/j.echo.2009.01.021
Rajagopalan N, Simon MA, Suffoletto MS, Shah H, Edelman K, Mathier MA, et al. Noninvasive estimation of pulmonary vascular resistance in pulmonary hypertension. Echocardiography. 2009;26(5):489–94. http://dx.doi.org/10.1111/j.1540-8175.2008.00837.x
Feigenbaum H. Mitral valve disease. In: Feigenbaum H, Amstrong W, Ryan T, editors. Echocardiography. 6th ed. Philadelphia: Lippincot Williams & Wilkins; 2005. p. 312–3.
Oh J, Seward J, Tajik A. Valvular heart disease. In: Oh J, Seward J, Tajik A, editors. The echo manual. 3rd ed. Rochester: Lippincott Williams & Wilkins; 2007. p. 201–7.
Lee KS, Abbas AE, Khandheria BK, Lester SJ. Echocardiographic assessment of right heart hemodynamic parameters. J Am Soc Echocardiogr. 2007;20(6):773–82. http://dx.doi.org/10.1016/j.echo.2007.03.002
Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1–25. http://dx.doi.org/10.1093/ejechocard/jen303
Anderson B. Doppler haemodynamic calculations. In: Anderson B, editor. Echocardiography. 1st ed. Brisbane: MGA Graphic; 2002. p. 123–46.
Rudski LG, Lai WW, Aﬁlalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713. http://dx.doi.org/10.1016/j.echo.2010.05.010
Tei C, Dujardin K, Hodge DO, Bailey KR, McGoon MD, Tajik AJ, et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996;9(6):838–47. http://dx.doi.org/10.1016/S0894-7317(96)90476-9
Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJM. Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue doppler and speckle tracking. Cardiovasc Ultrasound. 2007;5(27):1–19. http://dx.doi.org/10.1186/1476-7120-5-27
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17. http://dx.doi.org/10.1186/1751-0473-3-17
Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138(11):923–36.
Steele PM, Fuster V, Cohen M, Ritter DG, McGoon DC. Isolated atrial septal defect with pulmonary vascular obstructive disease--long-term follow-up and prediction of outcome after surgical correction. Circulation. 1987;76(5):1037–42. http://dx.doi.org/10.1161/01.CIR.76.5.1037
Krishnamoorthy KM, Dash PK. Factors affecting immediate changes in cardiac output following balloon mitral valvulotomy: the role of pulmonary hemodynamics. J Heart Valve Dis. 2009;18(2):128–34.
Anderson B. Doppler assessment of left ventricular systolic and diastolic function. In: Anderson B, editor. Echocardiography. 1st ed. Brisbane: MGA Graphic; 2002. p. 222–3.
Vlahos AP, Feinstein JA, Schiller NB, Silverman NH. Extension of doppler -derived echocardiographic measures of pulmonary vascular resistance to patients with moderate or severe pulmonary vascular disease. J Am Soc Echocardiogr. 2008;21(6):711–4. http://dx.doi.org/10.1016/j.echo.2007.10.004
Benza R, Tallaj J. Pulmonary hypertension out of proportion to left heart disease. Adv Pulm Hypertens. 2006;5:21–9.
Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation. 2008;117:1717–31. http://dx.doi.org/10.1161/CIRCULATIONAHA.107.653584
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