Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

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Abstract

Objectives: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. Results: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. Conclusions: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.

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Most cited references 18

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Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.

Richard Devereux, Daniel R. Alonso, Elizabeth M. Lutas … (1986)

To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)

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Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation.

P G Yock, R L Popp (1984)

We evaluated the accuracy of a noninvasive method for estimating right ventricular systolic pressures in patients with tricuspid regurgitation detected by Doppler ultrasound. Of 62 patients with clinical signs of elevated right-sided pressures, 54 (87%) had jets of tricuspid regurgitation clearly recorded by continuous-wave Doppler ultrasound. By use of the maximum velocity (V) of the regurgitant jet, the systolic pressure gradient (delta P) between right ventricle and right atrium was calculated by the modified Bernoulli equation (delta P = 4V2). Adding the transtricuspid gradient to the mean right atrial pressure (estimated clinically from the jugular veins) gave predictions of right ventricular systolic pressure that correlated well with catheterization values (r = .93, SEE = 8 mm Hg). The tricuspid gradient method provides an accurate and widely applicable method for noninvasive estimation of elevated right ventricular systolic pressures.

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Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound.

Marvin Berger, Azriel Haimowitz, Andrew Van Tosh … (1985)

Doppler ultrasound examination was performed in 69 patients with a variety of cardiopulmonary disorders who were undergoing bedside right heart catheterization. Patients were classified into two groups on the basis of hemodynamic findings. Group I consisted of 20 patients whose pulmonary artery systolic pressure was less than 35 mm Hg and Group II consisted of 49 patients whose pulmonary artery systolic pressure was 35 mm Hg or greater. Tricuspid regurgitation was detected by Doppler ultrasound in 2 of 20 Group I patients and 39 of 49 Group II patients (p less than 0.001). Twenty-six of 27 patients with pulmonary artery systolic pressure greater than 50 mm Hg had Doppler evidence of tricuspid regurgitation. In patients with tricuspid regurgitation, continuous wave Doppler ultrasound was used to measure the velocity of the regurgitant jet, and by applying the Bernoulli equation, the peak pressure gradient between the right ventricle and right atrium was calculated. There was a close correlation between the Doppler gradient and the pulmonary artery systolic pressure measured by cardiac catheterization (r = 0.97, standard error of the estimate = 4.9 mm Hg). Estimating the right atrial pressure clinically and adding it to the Doppler-determined right ventricular to right atrial pressure gradient was not necessary to achieve accurate results. These findings indicate that tricuspid regurgitation can be identified by Doppler ultrasound in a large proportion of patients with pulmonary hypertension, especially when the pulmonary artery pressure exceeds 50 mm Hg. Calculation of the right ventricular to right atrial pressure gradient in these patients provides an accurate noninvasive estimate of pulmonary artery systolic pressure.

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Author and article information

Journal

Journal ID (publisher-id): CRD

Journal ID (nlm-ta): Cardiology

Journal ID (doi): 10.1159/issn.0008-6312

Title: Cardiology

Publisher: S. Karger AG

ISSN (Print): 0008-6312

ISSN (Electronic): 1421-9751

Publication date Subscription-year: 2014

Publication date (Print): September 2014

Publication date (Electronic): 10 September 2014

Volume: 129

Issue: 2

Pages: 111-116

Affiliations

^aJerusalem Institute of Aging Research, ^bDepartment of Geriatrics and Rehabilitation, and ^cHeart Institute, Hadassah-Hebrew University Medical Center and Hebrew University Hadassah Medical School, Jerusalem, Israel

Author notes

*David Leibowitz, MD, Coronary Care Unit, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem 91240 (Israel), E-Mail oleibo@hadassah.org.il

Article

Publisher ID: 365137 Other ID: Cardiology 2014;129:111-116

DOI: 10.1159/000365137

PubMed ID: 25227337

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