Exploring the role of non-invasive tricuspid dP/dt as a marker of right ventricular function

Singbal, Yash, Vollbon, William, Huynh, Luan Tan, Wang, William Y. S., Ng, Arnold C. T. and Wahi, Sudhir (2015) Exploring the role of non-invasive tricuspid dP/dt as a marker of right ventricular function. Echocardiography, 32 9: 1347-1351. doi:10.1111/echo.12877


Author Singbal, Yash
Vollbon, William
Huynh, Luan Tan
Wang, William Y. S.
Ng, Arnold C. T.
Wahi, Sudhir
Title Exploring the role of non-invasive tricuspid dP/dt as a marker of right ventricular function
Journal name Echocardiography   Check publisher's open access policy
ISSN 0742-2822
1540-8175
Publication date 2015-09
Sub-type Article (original research)
DOI 10.1111/echo.12877
Open Access Status Not Open Access
Volume 32
Issue 9
Start page 1347
End page 1351
Total pages 5
Place of publication Hoboken, NJ, United States
Publisher Wiley-Blackwell
Collection year 2016
Formatted abstract
Background: Right ventricular (RV) function assumes prognostic significance in various disease states, but RV geometry is not amenable to volumetric assessment by two-dimensional echocardiography. Intra-ventricular pressure rate of rise (dP/dt) predicts myocardial contractility and adjusting for the maximal regurgitant velocity (Vmax) corrects for preload. We examined the relationship of noninvasive tricuspid dP/dt and dP/dt/Vmax with RV ejection fraction (RVEF) by cardiac magnetic resonance imaging (CMR) as a measure of RV function.

Methods: Fifty CMRs and echocardiograms performed within 30 days were included. Tricuspid regurgitation (TR) spectral Doppler trace was analyzed offline. TR dP/dt was calculated using simplified Bernoulli equation (dP/dt between 1 and 2 m/sec). dP/dt/Vmax was calculated as a ratio of dP/dt and TR Vmax. RV end-diastolic (EDV) and end-systolic volumes (ESV) were obtained from contouring of steady-state-free precession axial stack CMR images; RVEF was calculated as [(RVEDV - RVESV)/RVEDV] × 100. RVEF >42% was considered normal.

Results: Majority of studies were suitable for analysis. Median age was 48 years (IQR = 36-63); 56.4% were female (n = 22/39). There was correlation between dP/dt and RVEF (r2 = 0.51, P < 0.01) which improved with dP/dt/Vmax (r2 = 0.59, P < 0.01). dP/dt >400 mmHg/sec had a positive predictive value of 91%, sensitivity and specificity of 74% and 84% respectively for normal RVEF. Inter-observer agreement and repeatability analysis showed no significant difference.

Conclusion: Tricuspid dP/dt correlates well with CMR RVEF. A dP/dt of more than 400 mmHg/sec strongly predicts normal RVEF. Adjusting for preload (dP/dt/Vmax) further improves this correlation.
Keyword Right ventricular function
Tricuspid regurgitation
Tricuspid dP/dt
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes http://www.ncbi.nlm.nih.gov/pubmed/?term=25556710

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
Centre for Advanced Imaging Publications
 
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Created: Mon, 14 Dec 2015, 09:01:14 EST by William Wang on behalf of Medicine - Princess Alexandra Hospital