Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography

• Published in: The American journal of cardiology Vol. 59; no. 6; pp. 662 - 668
• Main Authors: Dabestani, Ali, Mahan, Gregory, Gardin, Julius M., Takenaka, Katsu, Burn, Cora, Allfie, Alice, Henry, Walter L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1987; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Blood Flow Velocity; Blood Pressure; Cardiovascular system; Echocardiography; Female; Humans; Hypertension - physiopathology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pulmonary Artery - physiology; Pulmonary Artery - physiopathology; Pulmonary Valve - physiology; Pulmonary Valve - physiopathology; Ultrasonic investigative techniques; Vascular Resistance; Doppler ultrasound study; Pulsed echo; Human; Resistance; Echocardiography; Pulmonary vessel; Ultrasonic investigation; Cardiovascular disease; Hemodynamics; Pressure; Pulmonary artery
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(87)91189-1

Pulsed Doppler echocardiography was used to examine the relation between pulmonary valve motion and pulmonary artery (PA) flow velocity patterns in 39 adults. In 16 patients with normal PA pressure (mean pressure less than 20 mm Hg), PA flow velocity accelerated slowly to a peak flow velocity at midsystole (time to peak flow velocity, or acceleration time = 134 ± 20 ms [mean ± standard deviation]), followed by a slow deceleration to the end of ejection, producing a “dome-like” appearance. In contrast, in 23 patients with elevated PA pressure (mean pressure 20 mm Hg or more), flow velocity accelerated rapidly to a peak flow velocity in early systole (acceleration time = 88 ± 25 ms, p <0.01), followed by rapid flow velocity deceleration to a nadir In midsystole. In 13 of these patients, a transient increase in flow velocity occurred in late systole, producing a “spike and dome” appearance. In patients with an acceleration time of 120 ms or less, there was a negative linear correlation with mean PA pressure, expressed by the equation: mean PA pressure = 90 − (0.62 × acceleration time). The standard error of the estimate was 8.3 mm Hg. A similar negative linear correlation was found between PA acceleration time and total pulmonary resistance. Using a PA acceleration time of 100 ms or less resulted in a 78% sensitivity and a 100% specificity for detection of elevated PA pressure. Although this Doppler method carrot precisely estimate PA pressure, I can be helpful in separating patients with normal pressure from those with elevated PA pressure.