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Evaluation of severity and prognosis
Several echocardiographic parameters have been shown to be predictive of prognosis in patients with pulmonary hypertension. Systolic PAP, estimated by Doppler echocardiography, however is not predictive for outcome [9].
The following parameters are useful to evaluate prognosis:
Other parameters describing RV systolic function are: Doppler tissue imaging (TDI) of the lateral tricuspid annulus, RV fractional area change (FAC).
With respect to echocardiography, in collaboration with the working group “Echocardiography and Cardiac Imaging” of the Swiss Society of Cardiology we recommend the following:
a) Likelihood of pulmonary hypertension based on echocardiographic findings
PH is unlikely
Pulmonary hypertension is possible
Pulmonary hypertension is likely
b) Assessment of PAP
Table
c) Assessment of RV function
Table
d) Indirect signs of pulmonary hypertension
Table
e) In addition, the echo report should include:
f) To identify patients likely to have pulmonary hypertension due to left heart disease or associated with congenital heart disease, the echo report should comment on:
Several echocardiographic parameters have been shown to be predictive of prognosis in patients with pulmonary hypertension. Systolic PAP, estimated by Doppler echocardiography, however is not predictive for outcome [9].
The following parameters are useful to evaluate prognosis:
- presence of pericardial effusion [9, 10]
- indexed right atrium area [9]
- LV eccentricity index [9]
- myocardial performance index (MPI) [11, 12]
- tricuspid annular plane systolic excursion (TAPSE) [13].
Other parameters describing RV systolic function are: Doppler tissue imaging (TDI) of the lateral tricuspid annulus, RV fractional area change (FAC).
With respect to echocardiography, in collaboration with the working group “Echocardiography and Cardiac Imaging” of the Swiss Society of Cardiology we recommend the following:
a) Likelihood of pulmonary hypertension based on echocardiographic findings
PH is unlikely
- estimated systolic PAP ≤ 36 mmHg, with
- no indirect signs of pulmonary hypertension and with normal RV systolic function
Pulmonary hypertension is possible
- estimated systolic PAP ≤ 36 mmHg, but with
- indirect signs of pulmonary hypertension or with abnormal RV systolic function orestimated systolic PAP is 37 – 50 mmHg
Pulmonary hypertension is likely
- Estimated systolic PAP > 50 mmHg
b) Assessment of PAP
Table
c) Assessment of RV function
Table
d) Indirect signs of pulmonary hypertension
Table
e) In addition, the echo report should include:
- systemic blood pressure at time of echocardiography
- cardiac output, calculated as described before
f) To identify patients likely to have pulmonary hypertension due to left heart disease or associated with congenital heart disease, the echo report should comment on:
- valvular heart disease (e.g. mitral insufficiency, aortic stenosis)
- LV diastolic and systolic function
- Intracardiac shunts
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SSPH Research Prize 2012
Deadline for submission: April 30, 2012
Further information
Symposium "pulmonal-arterielle Hypertension im Kindesalter"
Donnerstag, 10. Mai 2012, 16.00-18.00, Bern
Further information:
5th International Congress of the Swiss Society of Pulmonary Hypertension (SSPH)
28.-29. September 2012, Thun, Congress Hotel Seepark Thun
Informationen: www.imk.ch/sgph2012
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