SIMULTANEOUS MEASUREMENT OF SYSTOLIC PULM ONARY-ARTERY PRESSURES BY CATHETERIZATION AND DOPPLER-ECHOCARDIOGRAPHY WITH CONTRAST

The aim of this study was to assess the value of echocardiographic con trast in measuring systolic pulmonary artery pressures. Thirty-four pa tients with an average age of 61 +/- 15 years undergoing right heart c athererisation had a simultaneous measurement of systolic pulmonary ar tery pressures by catheter and colour-coded Doppler echocardiography u nder basal conditions and after injection of 5 % dextrose agitated wit h 1 cm3 of air to form microcavitations. The Doppler echocardiographic measurements were performed after withdrawal of the catheter into the inferior vena cava before and after injection of contrast. Patients w ere divided into two groups according to the pulmonary artery pressure s at catheterisation: Group I, comprising 11 patients with systolic pu lmonary artery pressures of less than 35 mmHg; Group II, comprising 23 patients with systolic pulmonary artery pressures of over 35 mmHg; Th e injection of contrast significantly increased the number of patients in whom systolic pulmonary artery pressures could be calculated from the Doppler signal of tricuspid regurgitation (TR) in Group I (control : 18 %; contrast: 100 %, p < 0.01) and Group II (control: 65 %; contra st: 96 %, p < 0.05). There was a close correlation between the cathete r and Doppler measurements of the trans-tricuspid valve pressure gradi ents before and after injection of contrast in Group I (n = 11, r = 0. 85, p = 0.001, with an estimated standard error (ESE) = 3.8 mmHg) and in Group II (control: n = 15, r = 0.89, p = 0.001, ESE = 10.5 mmHg, an d after contrast: n = 22, r = 0.90, p = 0.001, ESE = 7.95 mmHg) with t he catheter in the right ventricle. These correlations were unaffected by catheter withdrawal to the inferior vena cava in Group I n = 10, r = 0.76, p = 0.001, ESE = 6.4 mmHg) and in Group II (control: n = 12, r = 0.87, p = 0.001, ESE = 11.3 mmHg; contrast: n = 22, r = 0.80, p = 0.001, ESE = 8.1 mmHg).The detection of TR by colour Doppler is improv ed by injection of contrast in Group II as a regurgitant jet was detec ted in 20 out of 23 patients without, and in all 23 patients with inje ction of contrast. The volume of regurgitation seemed to increase (gai n of one + with contrast).