A feasible method for non-invasive measurement of pulmonary vascular resistance in pulmonary arterial hypertension: Combined use of transthoracic Doppler-echocardiography and cardiac magnetic resonance. Non-invasive estimation of pulmonary vascular resistance

• Published in: International journal of cardiology. Heart & vasculature 2015-12, Vol.9 (C), p.22-27
• Main Authors: Yan, Chaowu, Xu, Zhongying, Jin, Jinglin, Lv, Jianhua, Liu, Qiong, Zhu, Zhenhui, Pang, Kunjing, Shi, Yisheng, Fang, Wei, Wang, Yang
• Format: Article
• Language: English
• Subjects: Cardiac magnetic resonance; Doppler echocardiography; Pulmonary arterial hypertension; Pulmonary vascular resistance
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2015.07.008

Transthoracic Doppler-echocardiography (TTE) can estimate mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) reliably, and cardiac magnetic resonance (CMR) is the best modality for non-invasive measurement of cardiac output (CO). We speculated that the combined use of TTE and CMR could provide a feasible method for non-invasive measurement of pulmonary vascular resistance (PVR) in pulmonary arterial hypertension (PAH). Right heart catheterization (RHC) was undertaken in 77 patients (17M/60F) with PAH, and simultaneous TTE was carried out to evaluate MPAP, PCWP and CO. Within 2days, CO was measured again with CMR in similar physiological status. Then, PVR was calculated with the integrated non-invasive method: TTE-derived (MPAP–PCWP)/CMR-derived CO and the isolated TTE method: TTE-derived (MPAP–PCWP)/TTE-derived CO, respectively. The PVR calculated with integrated non-invasive method correlated well with RHC-calculated PVR (r=0.931, 95% confidence interval 0.893 to 0.956). Between the integrated non-invasive PVR and RHC-calculated PVR, the Bland–Altman analysis showed the satisfactory limits of agreement (mean value: −0.89±2.59). In comparison, the limits of agreement were less satisfactory between TTE-calculated PVR and RHC-calculated PVR (mean value: −1.80±3.33). Furthermore, there were excellent intra- and inter-observer correlations for the measurements of TTE and CMR (P