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PULMONARY ARTERY SYSTOLIC PRESSURE USING SALINE CONTRAST TEE

^* Division of Cardiac Anesthesia & Intensive Care, Division of Cardiology,
Toronto General Hospital, University of Toronto, Ontario, Canada

INTRODUCTION

Tricuspid regurgitation (TR) velocity measured on spectral Doppler is used to calculate right ventricular systolic pressure (RVSP) in Transesophageal Echocardiography (TEE).¹ RVSP equals pulmonary artery systolic pressure (PASP). Saline contrast may enhance the weak spectral TR velocity signal obtained with colour flow Doppler (CFD).² In this study, we compared RVSP obtained without saline contrast (RSVP-1) and with saline (RSVP-2) to PASP measured by pulmonary artery catheter (PAC).

METHODS

After IRB approval, 6 patients under going CABG were studied. 2-D, spectral with CFD examination of tricuspid valve was conducted in transverse 0⁰ and longitudinal 90⁰ mid esophageal view using Multi-plane TEE probe attached to the echocardiograph (Sonos-5500, Agilent Tech.). Patients with intra-cardiac shunt were excluded. Continuous wave Doppler TR velocity spectrum with measurements of maximum velocity (V) guided by CFD, without saline contrast was obtained. This procedure was repeated after 7cc of saline, agitated with air to produce micro-bubbles were injected into a peripheral vein to opacify the right atrium. PASP and central venous pressure (CVP) were measured simultaneously by PAC. All measurements were obtained at end expiration. Trans-tricuspid gradient (P) was calculated using modified Bernoulli equation, P = 4V2. RVSP was calculated by adding CVP to P. RVSP-1 and RVSP-2 were compared to PASP from PAC using bias and precision statistical analysis.

RESULTS

Saline contrast produced denser and more complete TR velocity spectral envelope. Comparison of RVSP-1 with PASP from PAC showed a mean difference of 1.833 mmHg, 95% CI –5.479 to 9.145. The limits of agreement between the two measurements were wide apart (-8.96 and 12.62). However, RVSP-2 and PASP showed a mean difference of only 0.001mmHg, 95% CI –2.82 to 2.82; and the limits of agreement were much closer (–5.39 and 5.39).

Saline contrast enhanced TR velocity spectrum which permitted easier measurement of RVSP when compared to CFD. This resulted in a closer agreement between RVSP obtained from TEE and PAP obtained from PAC. Contrast TEE may be useful substitute to PAC in monitoring PASP.

REFERENCES

1 York PG, Popp RL. Circulation 1991;83:817-821.[Abstract/Free Full Text]

2 Hagler DJ, Seward JB, Tajik et al. Echocardiography 1987;4:63–67.

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