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Non invasive estimation of pulmonary vascular resistance
 

Non invasive estimation of pulmonary vascular resistance

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Non invasive assessment of PVR in congenital heart disease

Non invasive assessment of PVR in congenital heart disease

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    Non invasive estimation of pulmonary vascular resistance Non invasive estimation of pulmonary vascular resistance Presentation Transcript

    • Non-invasive estimation of pulmonary vascular resistance Congenital 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 PULMONARY VASCULAR RESISTANCE BY DOPPLER ECHOCARDIOGRAPHY. J AM SOC 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/TVIRVO T × 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