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Review
. 2012 Sep 1;21(125):239-48.
doi: 10.1183/09059180.00003912.

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Luke S Howard  1 , Julia Grapsa, David Dawson, Michael Bellamy, John B Chambers, Navroz D Masani, Petros Nihoyannopoulos, J Simon R Gibbs
Affiliations
Review

Echocardiographic assessment of pulmonary hypertension: standard operating procedure

Luke S Howard et al. Eur Respir Rev. .

Erratum in

  • Eur Respir Rev. 2012 Dec 1;21(126):370

Abstract

Patients with suspected pulmonary hypertension (PH) should be evaluated using a multimodality approach to ensure that they receive a correct diagnosis. The series of investigations required includes clinical evaluation, noninvasive imaging techniques and right heart catheterisation (considered to be the "gold standard" for the diagnosis of PH). Current guidelines recommend that a detailed echocardiographic assessment is performed in all patients with suspected PH. In this review we summarise a protocol adopted by the National Pulmonary Hypertension Centres of UK and Ireland and approved by the British Society of Echocardiography for the evaluation of these patients. The views and measurements described are recommended for diagnosis, assisting in prognosis and providing a noninvasive means of following disease progression or response to therapy.

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Conflict of interest statement

Statement of Interest

P. Nihoyannopoulos has received research and educational grants from General Electric and from BRACCO Pharmaceuticals for organising educational meetings. He has also received fees (less than £1,000) for consulting from General Electric.

Figures

Figure 1.
Figure 1.
a) Normal parasternal long-axis view. Note that the right ventricle is less than one third of the size of the left ventricle. b) Parasternal long-axis view in pulmonary hypertension (PH). Severely dilated right ventricle with hypertrophy of the moderator band and the right ventricular free wall. The left ventricular cavity is small due to chronic right ventricular pressure overload. c) Normal parasternal long-axis view of the right ventricular outflow tract (RVOT) showing the main pulmonary trunk, branches of the pulmonary artery and the pulmonary valve. d) Parasternal long-axis view of the RVOT in PH showing the dilated pulmonary artery and branches. e) Normal apical four-chamber view. f) Apical four-chamber view in PH showing marked right ventricular dilation and hypertrophy.
Figure 2.
Figure 2.
a) Measurement of the peak tricuspid regurgitant velocity. b) Pulmonary regurgitant velocity at the start of diastole (PRVbd) and end-diastole (PRVed). c) Acceleration time (AT) measured across the pulmonary outflow tract in the parasternal short-axis view. d) Right atrial pressure: M-mode during sniff manoeuvre.
Figure 3.
Figure 3.
a) Measurement of the right atrial a) area and b) long axis for calculation of right atrial volume. c) Measurement of the left ventricular eccentricity index in c) end-diastole and d) end-systole. DI: minor axis perpendicular to the septum; D2: minor axis of the left ventricle parallel to the septum.
Figure 4.
Figure 4.
a) Measurement of myocardial performance index (MPI) using tissue Doppler imaging. S’: systolic wave; IVCT: isovolumic contraction time; IVRT: isovolumic relaxation time. b) Measurement of tricuspid annular plane systolic excursion (TAPSE); ET: ejections time.
Figure 5.
Figure 5.
An algorithm for investigating pulmonary hypertension (PH) using echocardiography. TRV: tricuspid regurgitant velocity; PRV: pulmonary regurgitant velocity; RV: right ventricle; LV left ventricle; PLAX: parasternal long axis; RVOT: right ventricular outflow tract; AT: acceleration time; TAPSE: tricuspid annular plane systolic excursion; IVRT: isovolumic relaxation time; IVC: inferior vena cava; RA: right atrium. #: in patients >60 yrs of age, a TRV ≥2.9 m·s−1 is used as a cut-off value [13].
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References

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