Echo-EaDPG, a simple Doppler-derived early-diastolic RV-pulmonary artery pressure gradient, demonstrated good discrimination (AUC = 0.90) for identifying clinically significant pulmonary regurgitation (CMR-PRF ≥ 25%) after RVOT reconstruction and may help identify patients who warrant CMR for quantitative PR evaluation.
Echo-EaDPG correlated significantly with CMR-derived pulmonary regurgitation fraction.
Echo-EaDPG correlated significantly with invasive catheter-measured early-diastolic RV-PA pressure gradient.
Echo-EaDPG was independently associated with clinically significant pulmonary regurgitation (CMR-PRF ≥ 25%) among tested echocardiographic indices in multivariable analysis.
Echo-EaDPG demonstrated good discrimination for identifying clinically significant pulmonary regurgitation on ROC analysis with bootstrap-supported robustness.
Interobserver agreement for Echo-EaDPG measurement was excellent.
This research examined whether a simple ultrasound (echocardiography) measurement could help doctors identify children and patients with repaired heart defects who have significant leakage of the pulmonary valve — a condition called pulmonary regurgitation (PR) — after surgery on the right side of the heart. The gold standard test for measuring how much the valve leaks is cardiac MRI (CMR), but MRI is not always easy to obtain, especially for children who may need sedation or whose centers lack regular access to it. The study looked at a specific Doppler measurement called the early-diastolic right ventricle-to-pulmonary artery pressure gradient (Echo-EaDPG), which estimates the pressure difference between the heart's right pumping chamber and the pulmonary artery at the beginning of the relaxation phase of the heartbeat. In 40 patients who had all three tests — echocardiography, cardiac MRI, and heart catheterization — within six months of each other, the Echo-EaDPG measurement correlated well with both the MRI-measured leak fraction and with the invasive catheter-measured pressure gradient. When used to identify patients with significant PR (defined as an MRI leak fraction of 25% or more), Echo-EaDPG performed well, with an area under the ROC curve of 0.90 (where 1.0 would be perfect discrimination). The measurement was also highly reproducible between different observers, with an intraclass correlation of 0.96. This research suggests that Echo-EaDPG — derived using a standard Doppler equation already familiar to cardiologists — could serve as a practical screening tool to help decide which patients need a cardiac MRI for more precise quantification of their pulmonary valve leakage. Rather than replacing MRI, it could help prioritize which patients most need that more detailed assessment, potentially improving follow-up care for patients who have had right ventricular outflow tract surgery, such as repair of tetralogy of Fallot.
Kawamura J, Ueno K, Shimozono T, Takahashi Y, Nakae K, Takumi K, et al.. (2026). Early-Diastolic Right Ventricle-Pulmonary Artery Pressure Gradient by Doppler Echocardiography to Guide Cardiac Magnetic Resonance Assessment of Pulmonary Regurgitation after Right Ventricular Outflow Tract Reconstruction.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70614