Abstract
Background According to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterization. How echocardiography predicts PH recently re-defined by a mean pulmonary artery pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by a pulmonary vascular resistance (PVR) >3 or >2 Wood units has not been established.
Methods A total of 278 patients referred for PH underwent a comprehensive echocardiography followed by a right heart catheterization. Fifteen patients (5.4%) were excluded because of insufficient quality echocardiography.
Results With PH defined by a mPAP >20 mmHg, 23 patients had no PH, 146 had pre-capillary and 94 post-capillary PH. At univariate analysis, maximum velocity of tricuspid regurgitation (TRV) ≥2.9 and ≤3.4 m s−1, left ventricle (LV) eccentricity index >1.1, right ventricle (RV) outflow tract (OT) notching or acceleration time <105 ms, RV-LV basal diameter >1 and PA diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m s−1 independently predicted PH. Additional independent prediction of PVR >3 Wood units was offered by LV eccentricity index >1.1 and RVOT acceleration time <105 ms and/or notching, but with no improvement of optimal combination of specificity and sensibility or positive prediction.
Conclusions Echocardiography as recommended in current guidelines can be used to assess the probability of re-defined PH in a referral center. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.
Footnotes
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Conflict of interest: Michele D'Alto reports participation on a monitoring board for Actelion-Janssen, Merk Sharp and Dohme, Dompè, Ferrer; outside the submitted work.
Conflict of interest: Marco Di Maio has nothing to disclose.
Conflict of interest: Emanuele Romeo has nothing to disclose.
Conflict of interest: Paola Argiento has nothing to disclose.
Conflict of interest: Ettore Blasi has nothing to disclose.
Conflict of interest: Alessandro Di Vilio has nothing to disclose.
Conflict of interest: Gaetano Rea has nothing to disclose.
Conflict of interest: Antonello D'Andrea has nothing to disclose.
Conflict of interest: Paolo Golino has nothing to disclose.
Conflict of interest: Robert Naeije reports lecture honoraria from AOP Pharmaceuticals; participation on a monitoring board for Johnson & Johnson, Actelion, Lung Biotechnology Corp, United Therapeutics; outside the submitted work.
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- Received September 22, 2021.
- Accepted December 10, 2021.
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