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Controlled Clinical Trial
. 2006 Apr;19(4):403-12.
doi: 10.1016/j.echo.2005.11.012.

Noninvasive Doppler tissue measurement of pulmonary artery compliance in children with pulmonary hypertension

Karrie Dyer  1 , Craig Lanning, Bibhuti Das, Po-Feng Lee, D Dunbar Ivy, Lilliam Valdes-Cruz, Robin Shandas
Affiliations
Controlled Clinical Trial

Noninvasive Doppler tissue measurement of pulmonary artery compliance in children with pulmonary hypertension

Karrie Dyer et al. J Am Soc Echocardiogr. 2006 Apr.

Abstract

Background: We have shown previously that input impedance of the pulmonary vasculature provides a comprehensive characterization of right ventricular afterload by including compliance. However, impedance-based compliance assessment requires invasive measurements. Here, we develop and validate a noninvasive method to measure pulmonary artery (PA) compliance using ultrasound color M-mode (CMM) Doppler tissue imaging (DTI).

Methods: Dynamic compliance (C(dyn)) of the PA was obtained from CMM DTI and continuous wave Doppler measurement of the tricuspid regurgitant velocity. C(dyn) was calculated as: [(D(s) - D(d))/(D(d) x P(s))] x 10(4); where D(s) = systolic diameter, D(d) = diastolic diameter, and P(s) = systolic pressure. The method was validated both in vitro and in 13 patients in the catheterization laboratory, and then tested on 27 pediatric patients with pulmonary hypertension, with comparison with 10 age-matched control subjects. C(dyn) was also measured in an additional 13 patients undergoing reactivity studies.

Results: Instantaneous diameter measured using CMM DTI agreed well with intravascular ultrasound measurements in the in vitro models. Clinically, C(dyn) calculated by CMM DTI agreed with C(dyn) calculated using invasive techniques (23.4 +/- 16.8 vs 29.1 +/- 20.6%/100 mm Hg; P = not significant). Patients with pulmonary hypertension had significantly lower peak wall velocity values and lower C(dyn) values than control subjects (P < .01). C(dyn) values followed an exponentially decaying relationship with PA pressure, indicating the nonlinear stress-strain behavior of these arteries. Reactivity in C(dyn) agreed with reactivity measured using impedance techniques.

Conclusion: The C(dyn) method provides a noninvasive means of assessing PA compliance and should be useful as an additional measure of vascular reactivity subsequent to pulmonary vascular resistance in patients with pulmonary hypertension.

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Figures

Figure 1
Figure 1
In vitro validation of color M-mode Doppler tissue imaging (CMM-TDI) to measure instantaneous diameter compared with intravascular ultrasound (IVUS).
Figure 2
Figure 2
Two-dimensional echocardiographic view (A) used to line color M-mode Doppler tissue imaging (CMM DTI) beam line and corresponding CMM DTI of right pulmonary artery (RPA) (B).
Figure 3
Figure 3
Results from analysis of color M-mode Doppler tissue imaging measurements from individual with normal pulmonary hemodynamics (A) and patient with pulmonary hypertension (B), showing instantaneous velocity, acceleration, and diameter of upper and lower walls of right pulmonary artery. Note different Y-axis scales between normotensive and hypertensive results. ECG, Electrocardiogram.
Figure 4
Figure 4
Comparison of invasively versus noninvasively obtained dynamic compliance (Cdyn) values for subset of patients of group II studied in catheterization laboratory.
Figure 5
Figure 5
Mean and SD for peak wall velocity (A) and dynamic compliance (Cdyn) (B) obtained from patients of group I. CMM-TDI, Color M-mode Doppler tissue imaging; PA, pulmonary artery; PH, pulmonary hypertension.
Figure 6
Figure 6
Dynamic compliance (Cdyn) plotted against pulmonary artery (PA) systolic pressure for both control subjects (circles) and patients with pulmonary hypertension (squares). Note nonlinear relationship, indicating mechanical response of PAs to pressure.
Figure 7
Figure 7
Dynamic compliance (Cdyn) against mean pulmonary artery (PA) pressure for 13 additional patients (group III) undergoing reactivity testing (oxygen and/or nitric oxide) in catheterization laboratory. Baseline (room air) (squares) and challenge (circles) conditions are shown for each patient. Changes in Cdyn with changes in pressure can be used to evaluate reactivity in compliance.
Figure 8
Figure 8
Preliminary data showing diameter–pressure plots obtained using color M-mode Doppler tissue imaging (CMM DTI) and invasively measured pressure digitized simultaneously into ultrasound scanner for control subject and patient with pulmonary hypertension (PH). Ability to obtain instantaneous diameter data allows such potentially more sophisticated types of analysis to be performed using CMM DTI.
See this image and copyright information in PMC

References

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