Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal: the “chin” vs the “beard”

Stephen J. Kyranis, Jilani Latona, David Platts, Natalie Kelly, Michael Savage, Martin Brown, Christian Hamilton-Craig, Gregory M. Scalia, Darryl Burstow

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Aim: Transthoracic echocardiography (TTE) is a fundamental investigation for the noninvasive assessment of pulmonary hemodynamics and right heart function. The aim of this study was to assess the correlation and agreement of Doppler calculation of right ventricular systolic pressure (RVSP) and pulmonary vascular resistance (PVR) using “chin” and “beard” measurements of tricuspid regurgitant velocity (TRV max), with invasive pulmonary artery systolic pressure (PASP) and PVR. Methods: One hundred patients undergoing right heart catheterisation (RHC) and near simultaneous transthoracic echocardiography were studied. TRV max was recorded for “chin” measurement (distinct peak TRV max signal) and where available (63 patients), “beard” measurement (higher indistinct peak TRV max signal). Results: Measurable TRV signal was obtained in 96 patients. Mean RVSP chin 54.7 ± 22.7 mm Hg and RVSP beard 68.6 = 23 ± 26.3 mm Hg (P <.001). There was strong correlation between both RVSP chin and RVSP beard with invasive PASP (Pearson’s r =.9, R 2 = 0.82, P <.001-r =.88, R =.78, P <.001, respectively.). Bland-Altman analysis for RVSP chin and RVSP beard showed a mean bias of −0.5 mm Hg (95% limits of agreement −21.4 to 20.5 mm Hg) and −10.7 (95% LOA −35.5 to 14.2 mm Hg), respectively. Receiver operator characteristics of TRV max “chin” and “beard” for diagnosis of pulmonary hypertension was assessed with optimal cut-offs being 2.8 m/s (sensitivity 93%, specificity 87%) and 3.2 m/s (sensitivity 91%, specificity 82%), respectively. There was similar correlation between PVR chin and PVR beard (r =.87, R 2 = 0.75, P <.001 and r =.86, R 2 = 0.74, P <.001, respectively). At higher PVR, there was overestimation of calculated PVR using PVR beard. Conclusion: The accuracy of noninvasive measurement of right heart pressures is increased using the “chin” in estimation of both RVSP and PVR.

Original languageEnglish
Pages (from-to)1085-1096
Number of pages12
Issue number8
Early online date20 Apr 2018
Publication statusPublished - Aug 2018
Externally publishedYes


  • echocardiography
  • pulmonary hypertension
  • tricuspid regurgitant velocity
  • TRV


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