alternative method for perioperative estimation of pulmonary artery systolic pressure by echocardiography

ABSTRACT

In the perioperative setting, pulmonary hypertension may be due to ischemic, left-sided valvular regurgitation and stenosis, residual shunt, pulmonary emboli or pericardial effusion. We purposed this study to determine whether tricuspid annular plane systolic excursion [TAPSE] and isovolumic relaxation time [IVRT] and S-wave velocity obtained by tissue Doppler imaging [TDI] could be used as an index of pulmonary systolic pressure in perioperative setting. Simultaneously, tricuspid annular plane systolic excursion and TDI by Echocardiography and right heart catheterization by Swan-Ganz catheter were performed in 55 patients [mean age 46 years,30 were male] with left -sided valvular disease [n=25], ischemic heart disease [n= 15] and adult-congenital heart disease [n= 10]. The TAPSE index S wave velocity from tricuspid annulus were measured by TDI. We also measured pulmonary artery systolic pressure [PASP] by right cardiac catheterization. In patients with moderate and severe pulmonary hypertension [PASP>45mmHg] the TAPSE value was [15.5 +/- 2.3mm]with sensivity of 90%and specifity of 80%. S wave velocity <11cm/s with sensivity of 90% and specifity of 86% and IVRT >79ms with sensivity of 93% and specifity of 95% [p<0.001]. Some factors such as underlying diseases [left-sided valvular disease, ischemic heart disease [IHD], congenital heart disease] had no effect on this correlation. We conclude that the evaluation of TAPSE index and IVRT and S-wave velocity by echocardiography provides a simple, rapid method for estimating of systolic pulmonary pressure in perioperative setting: