Diagnostic value of resting tricuspid regurgitation velocity and right ventricular ejection flow parameters for the detection of exercise induced pulmonary arterial hypertension

Our objectives were to evaluate resting tricuspid regurgitation velocity (T RV) and right ventricular outflow tract velocity curve (RVOTvc) profiles as markers for development of exercise induced pulmonary arterial hypertensio n (ExPHT). ExPHT is an elusive cause of dyspnea and fatigue. When present, Doppler echocardiography can detect and quantify elevated pulmonary pressur e. However, the characteristics and diagnostic value of resting TRV and RVO T(v)c indices in patients with ExPHT have not been fully addressed. The stu dy population consisted of 52 subjects (mean age 40.5 +/- 10.9, range 22-68 years) and was divided into three subsets as follows: 1. Patients (n = 22) with overt pulmonary hypertension (PHT), 2. Patients (n = 8) with ExPHT, 3 . Healthy, asymptomatic volunteers (n = 22). RVOTvc indices included: Mean and peak velocity, systolic velocity time integral (VTI); velocity time int egral at peak velocity (VTImax), acceleration time; ejection time. TRV was used as an index of pulmonary artery systolic pressure. There were signific ant differences between normals and ExPHT for TRV, acceleration time, VTIVm ax. TRV and VTImax were predictive of EXPHT in a logistic regression model. Conclusion: (1) Patients with ExPHT have distinct Doppler velocity pattern s suggesting the presence of a compromised pulmonary vascular bed even with normal pulmonary pressure at rest. (2) TRV and RVOTvc indices have potenti al diagnostic value in the early detection of ExPHT.