Non invasive assessment of PVR in congenital heart disease

1. Non-invasive estimation of
pulmonary vascular
resistance
Congenital heart disease

2. TWO VARIABLES
• TRV
• RVOT VTI

3. TWO FORMULAS
• TRV/TVIRVOT × 10 + 0.16(Abbas E et al)
• PVRDoppler (WU) = 37.96 × (TRV/ VTIRVOT)−0.131(Arindam P et al)

4. 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

5. ECHOCARDIOGRAPHIC EVALUATION
• Tricuspid regurgitation velocity (TRV)
• Velocity time integral of the right-ventricular outflow tract (VTIRVOT).

6. USEFUL FOR CHD WITHOUT PULMONARY
OUTFLOW TRACT OBSTRUCTION
• VSD
• ASD
• PDA
• AP WINDOW
• ASD+VSD
• ASD+VSD+PDA

7. FORMULA
ECHOCARDIOGRAGHY CARDIC CATHETERISATION
PVRDoppler (WU) = 37.96 × (TRV/
VTIRVOT)−0.131

8. 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)

9. 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]

10. 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]

11. BLAND-ALTMAN ANALYSIS
• Very good the limits of agreement
between PVRDoppler and PVRcath at a
PVR around 6

12. 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).

13. 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

14. TAKE HOME
• Doppler-derived ratio of TRV/VTIRVOT is a simple, non-invasive index, which can
be used to estimate PVR

15. RADIATION FROM YOUR CELL PHONE
AFFECTS MIGRATORY BIRDS