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 ), 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 was recorded for "chin" measurement (distinct peak TRV signal) and where available (63 patients), "beard" measurement (higher indistinct peak TRV signal).

RESULTS

Measurable TRV signal was obtained in 96 patients. Mean RVSP 54.7 ± 22.7 mm Hg and RVSP 68.6 = 23 ± 26.3 mm Hg (P < .001). There was strong correlation between both RVSP and RVSP with invasive PASP (Pearson's r = .9, R  = 0.82, P < .001 - r = .88, R = .78, P < .001, respectively.). Bland-Altman analysis for RVSP and RVSP 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 "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 and PVR (r = .87, R  = 0.75, P < .001 and r = .86, R  = 0.74, P < .001, respectively). At higher PVR, there was overestimation of calculated PVR using PVR .

CONCLUSION

The accuracy of noninvasive measurement of right heart pressures is increased using the "chin" in estimation of both RVSP and PVR.