Abstract
To assess the validity of ultrasound criteria for pulmonary arterial hypertension, we studied pulmonary valve motion in 28 patients and 20 normal subjects. In the latter group, we categorised normal movement of the posterior leaflet of the pulmonary valve in a fashion not previously described. Of the 28 patients, 19 had pulmonary arterial hypertension (pulmonary artery mean pressure more than 20 mmHg, range 22 to 72). Negative, flat, and positive e to f slopes occurred equally in normal subjects and patients. Maximal a wave excursion was less than 2 mm in 9 of 13 patients with pulmonary hypertension who had sinus rhythm, but was more than 2 mm in all normals and in the 9 patients with normal pulmonary artery pressure (69% sensitivity and 100% specificity). The b to c slope was more than 450 mm/s in 6 of 18 patients with pulmonary arterial hypertension and was less than 450 mm/s in all others (33% sensitivity and 100% specificity). The normalised right ventricular pre-ejection period was more than 0.095 (range 0.10 to 0.16) in 13 of the 19 patients with pulmonary arterial hypertension and less than 0.095 in all others (68% sensitivity and 100% specificity). A midsystolic notch occurred in patients with pulmonary arterial hypertension and in no normal subjects or patients with normal pulmonary arterial pressure. Of the 19 patients with pulmonary arterial hypertension, 18 were identified by one or more ultrasound criteria. Of the 5 patients who met only 1 criterion (increased normalised right ventricular pre-ejection period), 4 had atrial fibrillation. We conclude that measurement of the pulmonary valve e to f slope is useless for identifying pulmonary arterial hypertension. However, changes in normalised right ventricular pre-ejection, maximal a wave excursion, b to c slope, and the presence of a midsystolic notch, while insensitive, are highly specific for pulmonary atrial hypertension.
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Selected References
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- Gramiak R., Nanda N. C., Shah P. M. Echocardiographic detection of the pulmonary valve. Radiology. 1972 Jan;102(1):153–157. doi: 10.1148/102.1.153. [DOI] [PubMed] [Google Scholar]
- Hirschfeld S., Meyer R., Schwartz D. C., Korfhagen J., Kaplan S. Measurement of right and left ventricular systolic time intervals by echocardiography. Circulation. 1975 Feb;51(2):304–309. doi: 10.1161/01.cir.51.2.304. [DOI] [PubMed] [Google Scholar]
- Nanda N. C., Gramiak R., Robinson T. I., Shah P. M. Echocardiographic evaluation of pulmonary hypertension. Circulation. 1974 Sep;50(3):575–581. doi: 10.1161/01.cir.50.3.575. [DOI] [PubMed] [Google Scholar]
- Sakamoto T., Matsuhisa M., Hayashi T., Ichiyasu H. Echocardiogram of the pulmonary valve. Jpn Heart J. 1974 Jul;15(4):360–373. doi: 10.1536/ihj.15.360. [DOI] [PubMed] [Google Scholar]
- Weyman A. E., Dillon J. C., Feigenbaum H., Chang S. Echocardiographic patterns of pulmonary valve motion in valvular pulmonary stenosis. Am J Cardiol. 1974 Nov;34(6):644–651. doi: 10.1016/0002-9149(74)90151-9. [DOI] [PubMed] [Google Scholar]
- Weyman A. E., Dillon J. C., Feigenbaum H., Chang S. Echocardiographic patterns of pulmonic valve motion with pulmonary hypertension. Circulation. 1974 Nov;50(5):905–910. doi: 10.1161/01.cir.50.5.905. [DOI] [PubMed] [Google Scholar]