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Echocardiographic probability of pulmonary hypertension: a validation study

Michele D'Alto, Marco Di Maio, Emanuele Romeo, Paola Argiento, Ettore Blasi, Alessandro Di Vilio, Gaetano Rea, Antonello D'Andrea, Paolo Golino, Robert Naeije
European Respiratory Journal 2021; DOI: 10.1183/13993003.02548-2021
Michele D'Alto
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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  • For correspondence: mic.dalto@tin.it
Marco Di Maio
2Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
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Emanuele Romeo
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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Paola Argiento
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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Ettore Blasi
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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Alessandro Di Vilio
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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Gaetano Rea
3Radiology Unit, Monaldi Hospital, Naples, Italy
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Antonello D'Andrea
4Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, Nocera Inferiore, Italy
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Paolo Golino
1Department of Cardiology, University “L. Vanvitelli” – Monaldi Hospital, Naples, Italy
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Robert Naeije
5Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
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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

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

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.

  • Received September 22, 2021.
  • Accepted December 10, 2021.
  • Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
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Echocardiographic probability of pulmonary hypertension: a validation study
Michele D'Alto, Marco Di Maio, Emanuele Romeo, Paola Argiento, Ettore Blasi, Alessandro Di Vilio, Gaetano Rea, Antonello D'Andrea, Paolo Golino, Robert Naeije
European Respiratory Journal Jan 2021, 2102548; DOI: 10.1183/13993003.02548-2021

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Echocardiographic probability of pulmonary hypertension: a validation study
Michele D'Alto, Marco Di Maio, Emanuele Romeo, Paola Argiento, Ettore Blasi, Alessandro Di Vilio, Gaetano Rea, Antonello D'Andrea, Paolo Golino, Robert Naeije
European Respiratory Journal Jan 2021, 2102548; DOI: 10.1183/13993003.02548-2021
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