Echocardiography in diagnosis of pulmonary hypertension

Echocardiography in diagnosis of pulmonary hypertension


Pulmonary hypertension can be defined as mean pulmonary artery pressure more than or equal to 25 mm Hg. Echocardiography is useful as a screening tool for early diagnosis of pulmonary hypertension. TR (tricuspid regurgitation) jet method for estimation of pulmonary pressure is time tested and easy to perform. The disadvantage is that it is not useful if a good TR jet is not there. TR jet may underestimate PA (pulmonary arterial) pressure in severe PAH and overestimate PA pressure in normal population. Mean PA pressure can be estimated from the peak gradient of the PR (pulmonary regurgitation) jet. PVR (pulmonary vascular resistance) can be estimated from the VTI (velocity time integral) of the TR jet. IVC size and inspiratory collapse is related to the right atrial pressure. TAPSE (tricuspid annular systolic excursion) gives a prognostic indication in case of pulmonary hypertension.

Tei index is a load independent index of RV systolic and diastolic function. Isovolumic contraction time plus isovolumic relaxation time divided by ejection time is known as Tei index [1]. It is a combined myocardial performance index.

Reference

  1. Bleeker GB, Steendijk P, Holman ER, Yu CM, Breithardt OA, Kaandorp TA, Schalij MJ, van der Wall EE, Nihoyannopoulos P, Bax JJ. Assessing right ventricular function: the role of echocardiography and complementary technologies. Heart. 2006 Apr;92 Suppl 1:i19-26.