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 journalArticleResearchpeer-review

Abstract

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.

LanguageEnglish
Pages1085-1096
Number of pages12
JournalEchocardiography
Volume35
Issue number8
Early online date20 Apr 2018
DOIs
Publication statusPublished - Aug 2018
Externally publishedYes

Fingerprint

Chin
Ventricular Pressure
Vascular Resistance
Blood Pressure
Pressure
Lung
Pulmonary Artery
Echocardiography
Sensitivity and Specificity
Patient Rights
Cardiac Catheterization
Pulmonary Hypertension
Hemodynamics

Keywords

  • echocardiography
  • pulmonary hypertension
  • tricuspid regurgitant velocity
  • TRV

Cite this

Kyranis, Stephen J. ; Latona, Jilani ; Platts, David ; Kelly, Natalie ; Savage, Michael ; Brown, Martin ; Hamilton-Craig, Christian ; Scalia, Gregory M. ; Burstow, Darryl. / Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal : the “chin” vs the “beard”. In: Echocardiography. 2018 ; Vol. 35, No. 8. pp. 1085-1096.
@article{3ac838e9731f433a88d2823e22933570,
title = "Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal: the “chin” vs the “beard”",
abstract = "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.",
keywords = "echocardiography, pulmonary hypertension, tricuspid regurgitant velocity, TRV",
author = "Kyranis, {Stephen J.} and Jilani Latona and David Platts and Natalie Kelly and Michael Savage and Martin Brown and Christian Hamilton-Craig and Scalia, {Gregory M.} and Darryl Burstow",
year = "2018",
month = "8",
doi = "10.1111/echo.13893",
language = "English",
volume = "35",
pages = "1085--1096",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell, Wiley",
number = "8",

}

Kyranis, SJ, Latona, J, Platts, D, Kelly, N, Savage, M, Brown, M, Hamilton-Craig, C, Scalia, GM & Burstow, D 2018, 'Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal: the “chin” vs the “beard”', Echocardiography, vol. 35, no. 8, pp. 1085-1096. https://doi.org/10.1111/echo.13893

Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal : the “chin” vs the “beard”. / Kyranis, Stephen J.; Latona, Jilani; Platts, David; Kelly, Natalie; Savage, Michael; Brown, Martin; Hamilton-Craig, Christian; Scalia, Gregory M.; Burstow, Darryl.

In: Echocardiography, Vol. 35, No. 8, 08.2018, p. 1085-1096.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Improving the echocardiographic assessment of pulmonary pressure using the tricuspid regurgitant signal

T2 - Echocardiography

AU - Kyranis, Stephen J.

AU - Latona, Jilani

AU - Platts, David

AU - Kelly, Natalie

AU - Savage, Michael

AU - Brown, Martin

AU - Hamilton-Craig, Christian

AU - Scalia, Gregory M.

AU - Burstow, Darryl

PY - 2018/8

Y1 - 2018/8

N2 - 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.

AB - 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.

KW - echocardiography

KW - pulmonary hypertension

KW - tricuspid regurgitant velocity

KW - TRV

UR - http://www.scopus.com/inward/record.url?scp=85054567226&partnerID=8YFLogxK

U2 - 10.1111/echo.13893

DO - 10.1111/echo.13893

M3 - Article

VL - 35

SP - 1085

EP - 1096

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 8

ER -