An Alternative Method for Perioperative Estimation of Pulmonary Artery Systolic Pressure by Echocardiography

Backgrounds: in the perioperative setting, pulmonary hypertension is due to ischemia, left-sided valvular regurgitation and stenosis, residual shunt, pulmonary emboli, pericardial effusion etc. the pulmonary artery (pa) pressure can be assessed by different methods, including invasive pulmonary catheters and pulsed doppler echocardiography. because of limitations of doppler echocardiography (conventional method) for evaluation of pa pressure, we purposed this study to determine whether tricuspid annular plane systolic excursion (tapse), isovolumic relaxation time (ivrt) and s-wave velocity obtained by tissue doppler imaging (tdi) can be used as indices of systolic pulmonary artery pressure in perioperative setting.materials and methods: simultaneously, tapse by 2-d echocardiography and tissue doppler velocity (tdv) study by doppler 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=18) and adult-congenital heart disease (n=12).the tapse index ,which is expressed as an absolute value (cm or mm), ivrt and s-wave velocity by tdi were measured. we also measured pulmonary artery systolic pressure by right cardiac catheterization.results: in patients with moderate and severe pulmonary hypertension (pasp>45mmhg) the tapse value was < 17.8 mm with sensivity of 90% and specifity of 80%, the s-wave velocity was <11cm/s with sensivity of 90% and specifity of 86% and the ivrt was >79ms with sensitivity of 93% and specificity of 95% (p<0.001). some factors such as underlying diseases (ischemic heart disease, congenital heart disease) had no effect on this correlation.conclusion: we conclude that evaluation of tapse index and ivrt and s-wave velocity by echocardiography provides a simple and rapid method for estimating systolic pulmonary artery pressure in perioperative setting