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Estimation of Pulmonary Vascular Resistance with Doppler Diastolic Gradients

Department of Pediatric Cardiology, The Aga Khan University Hospital
¹ National Institute of Cardiovascular Diseases, Karachi, Pakistan

For reprint information contact: Mehnaz Atiq, MD, Tel: 92 21 493 0051 Ext. 4722, Fax: 92 21 493 4294, Email: mehnaz.atiq{at}aku.edu, Department of Pediatrics, The Aga Khan University Hospital, PO Box 3500, Karachi-74800, Pakistan.

This study was undertaken to determine the diastolic Doppler echocardiographic correlates of pulmonary vascular resistance calculated on cardiac catheterization in patients with secondary pulmonary arterial hypertension. Thirty-eight consecutive patients with congenital heart disease, pulmonary artery hypertension and pulmonary regurgitation were studied. Continuous-wave Doppler-derived pulmonary artery diastolic gradients were measured at 3 points on the pulmonary regurgitant diastolic velocity slope: peak diastolic, end-diastolic (at the R wave on the electrocardiogram), and mid-diastolic (midway between the peak and end-diastolic points). Catheterization data included oximetry, measurements of pressure in the cardiac chambers and great arteries, and calculation of pulmonary vascular resistance index. Doppler-derived peak, mid, and end-diastolic pulmonary regurgitation gradients correlated best with catheterization-measured pulmonary artery systolic, mean and diastolic pressures, respectively. The best Doppler correlate of pulmonary vascular resistance index was the pulmonary artery end-diastolic gradient. Clinically useful information can be obtained from Doppler pulmonary artery diastolic gradients measured on the pulmonary regurgitant diastolic velocity slope, which can estimate the pulmonary arterial pressure as well as pulmonary vascular resistance obtained on cardiac catheterization.