Original articleNoninvasive Doppler Tissue Measurement of Pulmonary Artery Compliance in Children with Pulmonary Hypertension
Section snippets
In Vitro Validation
The method uses color M-mode (CMM) Doppler tissue imaging (DTI) to obtain instantaneous diameter of the PA, and couples this with noninvasively obtained peak systolic PA pressure by measurement of the tricuspid regurgitant (TR) jet velocity by continuous wave Doppler, to measure compliance. The CMM DTI method is a newly developed technique to measure instantaneous diameter. We first evaluated the use of CMM DTI in measuring diameter using a previously described in vitro model of an elastic PA.1
In Vitro Validation
Figure 1, A, shows instantaneous diameter measured using IVUS and using CMM DTI for one of the elastic mock arteries used in vitro, and Figure 1, B, shows an agreement analysis for all data points. As can be seen, good agreement between the two methods was found. In fact, CMM DTI provides a more temporally resolved trace of diameter because it has better temporal resolution than IVUS.
Clinical Studies
Demographic data for the control and hypertensive subjects are provided in Table 1, Table 2. Excellent CMM DTI
Discussion
The prognosis and management of pediatric PH primarily depend on assessment of vasoreactivity.4, 8 Conventionally, vasoreactivity has been measured by PVR, and recent work has shown the use of PVR with clinical challenge to predict outcomes in children with idiopathic PH.9 Although PVR provides valuable information, there are several important limitations to its exclusive use. First, PVR requires the use of invasive methods. We have recently introduced a novel noninvasive method of estimating
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2014, Archives of Cardiovascular DiseasesCitation Excerpt :Pulmonary vascular capacitance (accounting for medium and large vessels), as assessed by echocardiography (stroke volume divided by pulmonary pulse pressure: [LVOT diameter2 × π/4 × subaortic VTI]/[4 × ([peak TR]2–[end-diastolic PR]2)]), is an independent predictor of outcomes in a cohort of adults with PAH [61]. Estimation of PA compliance, to determine the pulsatile nature of the PA flow, can be obtained using colour M-mode tissue Doppler imaging on the right PA (to measure diameters) and peak TR gradient (compliance [dyne] = [PA systolic–diastolic diameter]/[diastolic diameter × systolic pressure] × 104) and correlates well with invasive measurement of compliance [62] in children, normal compliance being >40% change/100 mmHg. Given its safety and technical progress, it is likely that the role of echocardiography in the management of PAH will increase in the future.
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Supported in part by grants from the National Institutes of Health (HL 067393, HL 072738).