by Mercado, Pablo;
Maizel, Julien; Beyls, Christophe; Kontar, Loay; Orde, Sam; Huang, Stephen;
McLean, Anthony; Tribouilloy, Christophe; Slama, Michel
Objectives:
Doppler echocardiography is a well-recognized technique for the noninvasive
evaluation of pulmonary artery pressure; however, little information is
available concerning patients receiving mechanical ventilation. Furthermore,
recent studies have debatable results regarding the relevance of this technique
to assess pulmonary artery pressure. The aim of our study was to reassess the
accuracy of Doppler echocardiography to evaluate pulmonary artery pressure and
to predict pulmonary hypertension.
Design:
Prospective observational study. Setting: Amiens ICU, France. Patients. ICU
patients receiving mechanical ventilation. Interventions: In 40 patients, we
simultaneously recorded Doppler echocardiography variables (including tricuspid
regurgitation and pulmonary regurgitation) and invasive central venous
pressure, systolic pulmonary artery pressure, diastolic pulmonary artery
pressure, and mean pulmonary artery pressure.
Measurements and Main Results: Systolic pulmonary artery pressure assessed from
the tricuspid regurgitation derived maximal pressure gradient added to the
central venous pressure demonstrated the best correlation with the invasive
systolic pulmonary artery pressure (r = 0.87) with a small bias (–3 mm Hg) and
a precision of 9 mm Hg. A Doppler echocardiography systolic pulmonary artery
pressure greater than 39 mm Hg predicted pulmonary hypertension (mean pulmonary
artery pressure ≥ 25 mm Hg) with 100% sensitivity and specificity. Tricuspid
regurgitation maximal velocity greater than 2.82 m/s as well as tricuspid
regurgitation pressure gradient greater than 32 mm Hg predicted the presence of
pulmonary hypertension. Pulmonary regurgitation was recorded in 10 patients
(25%). No correlation was found between pulmonary regurgitation velocities and
either mean pulmonary artery pressure or diastolic pulmonary artery pressure.
Pulmonary acceleration time less than 57 ms and isovolumic relaxation time less
than 40 ms respectively predicted pulmonary hypertension 100% of the time and
had a 100% negative predictive value. Conclusions:
Tricuspid regurgitation maximal velocity pressure gradient added to invasive
central venous pressure accurately estimates systolic pulmonary artery pressure
and mean pulmonary artery pressure in ICU patients receiving mechanical
ventilation and may predict pulmonary hypertension.
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