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Noninvasive assessment of pulmonary vascular resistance by doppler echocardiography

journal contribution
posted on 2023-05-17, 20:57 authored by Abbas, AE, Franey, LM, Thomas MarwickThomas Marwick, Maeder, MT, Kaye, DM, Vlahos, AP, Serra, W, Al-Azizi, K, Schiller, NB, Lester, SJ

Background: The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVIRVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVIRVOT x 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (> 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVIRVOT was also compared with that of a new ratio, TRV 2/TVIRVOT, in patients with markedly elevated PVR (>6 WU).

Methods: Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVR cath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV2/TVIRVOT. Both PVRecho and a new derived regression equation based on TRV2/TVIRVOT: 5.19 x TRV 2/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV2/TVIRVOT were obtained to predict PVR > 6 WU.

Results: One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P <.0001, Z = 0.92). There was a better correlation between PVRcath and TRV2/TVIRVOT (r = 0.79, P <.0001, Z = -0.01) in the entire cohort as well as in patients with PVR > 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR > 6 WU. TRV2/TVIRVOT and TRV/TVIRVOT both predicted PVR > 6 WU with good sensitivity and specificity.

Conclusions: 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.


Publication title

Journal of the American Society of Echocardiography










Menzies Institute for Medical Research



Place of publication

Inc, 11830 Westline Industrial Dr, St Louis, USA, Mo, 63146-3318

Rights statement

Copyright 2013 American Society of Echocardiography

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  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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