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Non invasive assessment of PVR in congenital heart disease
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Non-invasive estimation of pulmonary vascular
resistanceCongenital heart disease
TWO VARIABLES
• TRV
• RVOT VTI
TWO FORMULAS
• TRV/TVIRVOT × 10 + 0.16(Abbas E et al)
• PVRDoppler (WU) = 37.96 × (TRV/ VTIRVOT)−0.131(Arindam P et al)
PERSPECTIVE
• PVR is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease accompanied by pulmonary arterial hypertension
• Better decide anatomy and physiology both by ECHO
• Choose a non-invasive strategy if sensitive/specificity is comparable to Invasive catheterization
ECHOCARDIOGRAPHIC EVALUATION
• Tricuspid regurgitation velocity (TRV)
• Velocity time integral of the right-ventricular outflow tract (VTIRVOT).
USEFUL FOR CHD WITHOUT PULMONARY OUTFLOW TRACT OBSTRUCTION
• VSD
• ASD
• PDA
• AP WINDOW
• ASD+VSD
• ASD+VSD+PDA
FORMULA
ECHOCARDIOGRAGHY CARDIC CATHETERISATION
PVRDoppler (WU) = 37.96 × (TRV/ VTIRVOT)−0.131
AGREEMENT :CATH VS. ECHO
• Linear regression plot for pulmonary vascular resistance at atheterization (PVRcath) versus (TRV)/( VTIRVOT) ratio (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001)
PVR OF 8 WU
TRV/VTIRVOT value of 0.17
sensitivity of 79.17%
specificity of 95%
Area under the ROC= 0. 0.923[ 95% CI 0.801 to 0.982]
PVR OF 6 WU
TRV/VTIRVOT value of 0.14
Sensitivity of 96.67%
specificity of 92.86%
Area under the ROC = 0.963,95%[ CI 0.858 to 0.997]
BLAND-ALTMAN ANALYSIS
• Very good the limits of agreement between PVRDoppler and PVRcath at a PVR around 6
ARINDAM PANDE ET.AL: NON-INVASIVE ESTIMATION OF PULMONARY VASCULAR RESISTANCE IN PATIENTS OF PULMONARY HYPERTENSION IN CONGENITAL HEART DISEASE WITH UNOBSTRUCTED PULMONARY FLOW . ANN OF PAED CARD: 2014 ; VOLUME : 7( 2 ): 92-97
PVRDoppler (WU) = 37.96 × (TRV/ VTIRVOT)−0.131
The TRV/VTIRVOT ratio correlated well with PVR measured at catheterization (PVRcath) (r = 0.896, 95% confidence interval [CI] 0.816 to 0.9423, P < 0.001). Using the Bland-Altman analysis, PVR measurements derived from Doppler data showedsatisfactory limits of agreement with catheterization estimated PVR. For a PVR of 6 Wood units (WU), a TRV/VTIRVOT value of 0.14 provided a sensitivity of 96.67% anda specificity of 92.86% (area under the curve 0.963, 95% confidence interval 0.858 to 0.997) and for PVR of 8 WU a RV/VTIRVOT value of 0.17 provided a sensitivity of 79.17% and a specificity of 95% (area under the curve 0. 0.923, 95% confidence interval
0.801 to 0.982).
ABBAS AE, FRANEY LM, MARWICK T, MAEDER MT, KAYE DM,VLAHOS AP, ET AL. NONINVASIVE ASSESSMENT OF PULMONARYVASCULAR RESISTANCE BY DOPPLER ECHOCARDIOGRAPHY. J AMSOC ECHOCARDIOGR 2013;26:1170-7
• TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT > 0.275, PVR is likely > 6 WU, and PVRecho2 derived from TRV(2)/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho
• PVR ≤6 WU : a good estimate of invasively derived PVR.PVR >6:This formula is less accurate
•TRV/TVIRVOT × 10 + 0.16
TAKE HOME
• Doppler-derived ratio of TRV/VTIRVOT is a simple, non-invasive index, which can be used to estimate PVR
RADIATION FROM YOUR CELL PHONE AFFECTS MIGRATORY BIRDS