PubMed · 8167174
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M R de Leval. 1994. Right heart bypass operations.. https://pubmed.ncbi.nlm.nih.gov/8167174/
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BACKGROUND: Doppler spectrum of tricuspid regurgitation (TR) is used to noninvasively assess right ventricular (RV) pressure. With mild TR, the native (Nat) TR envelope may not allow accurate pressure evaluation. Proprietary contrast agents, such as Levovist (Lev) can be used to augment TR Doppler and opacify right-sided heart chambers, but they are expensive, and their efficacy has not been objectively evaluated in patients with difficult baseline studies or compared with less expensive saline (Sal) or colloid solutions, such as Gelofusine (Gel). METHODS: Twenty-five consecutive patients with poor quality Nat TR envelopes on transthoracic echocardiogram were reexamined after serial intravenous injection of 3 contrast agents (Sal, Gel, and Lev). Doppler signals for each agent recorded on video and digitally on optical disk were assessed for signal quality, estimated RV pressure, interobserver and intraobserver variation, and longevity of signal. Quality of right ventricular-right atrial (RV-RA) opacification was also determined for Sal and Gel. Of the 25 patients, 9 underwent percutaneous right-sided heart catheterization. We used the pressures obtained from the catheterization to independently evaluate the pressure estimates from echocardiography. RESULTS: All 3 contrast agents significantly improved the mean quality grade (grades 0-5) of TR envelopes (Nat 1.12, Sal 1.97, Gel 2.56, Lev 2.41, P <.001), decreased the number of uninterpretable envelopes (grade 0) (Nat 49%, Sal 12%, Gel 4%, Lev 12%, P <.0001 for comparison of each agent relative to Nat), and improved the correlation between echocardiographic and catheter-derived RV-RA pressure measurements (Nat r = 0.65, Sal r = 0.75, Gel r = 0.90, Lev r = 0.88). The persistence of enhanced Doppler signals of interpretable quality (> grade 1) was greater for Lev (15.8 seconds) and Gel (15 seconds) than Sal (7.6 seconds) (P =.002). Opacification of RV and RA, measured as mean luminosity score during 2-dimensional harmonic imaging, was significantly higher for Gel than Sal (92.84 +/- 31.2 vs 56.06 +/- 25.6, respectively; P =.0003). Sal, Gel and Lev, respectively, cost $0.10, $2.50, and $75.00 per study. CONCLUSION: Agitated colloid is a novel, effective, and inexpensive alternative to proprietary agents and saline for the assessment of pulmonary systolic pressure and right-sided heart opacification.
INTRODUCTION: Central venous pressure (CVP) is an important hemodynamic parameter, reflecting the patient's volume status. Although some studies of non-invasive evaluation of CVP by echocardiography exist, an exact quantitative method has not been described. OBJECTIVES: Analyzing several echocardiographic variables, the authors present an equation to calculate CVP with good statistical correlation with CVP measured invasively. MATERIAL AND METHODS: The study included 45 patients, 32 undergoing mechanical ventilation, 32 in sinus rhythm and 13 with atrial fibrillation. Patients underwent simultaneous CVP measurement and transthoracic Doppler echocardiography. Statistical analysis was performed using bivariate correlation and analysis of variance. RESULTS: Several echocardiographic parameters measured showed a good correlation with the measured CVP. Standardized coefficients were applied to them and an equation to calculate CVP was obtained (tricuspid E decelaration) x 0.11 + (RU/RA gradient) x 0.16 - (IVC variation). CONCLUSION: This new method seems reliable to evaluate non-invasively a hemodynamic parameter that until now has only been measured approximately by this approach.