scholarly journals The Accuracy and Influencing Factors of Doppler Echocardiography in Estimating Pulmonary Artery Systolic Pressure: Comparison With Right Heart Catheterization : A Retrospective Cross-sectional Study

2021 ◽  
Author(s):  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Influencing Factors ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Signal Quality ◽  
Right Heart ◽  
Ordinal Regression Analysis

Abstract Background: Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH). But high proportion of overestimation or underestimation of sPAPECHO still remained. So we aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as reference. Methods: A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to compared the diagnostic efficacy of sPAPECHO with other TR related methods. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ±10% as the boundary. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis.Results: sPAPECHO had the greatest correlation coefficient (r=0.781, P<0.001), best diagnostic efficiency (AUC=0.98) and lowest bias (mean bias= 0.07mmHg, 95% limits of agreement: -32.08 to +32.22mmHg) compared with other TR related methods. Ordinal regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32) , respectively. Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. While TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO. Conclusions: sPAPECHO was superior to other TR-related methods in PH screening, and was often overestimated in patients with pre-capillary PH at low sPAPRHC level, even with good TR signal quality.Trial registration: This is a retrospectively registered study.

scholarly journals Accuracy and Influencing factors of Pulmonary Artery Systolic Pressure estimated by Doppler Echocardiography: Comparsion with Right Heart Catheterization

2021 ◽  
Author(s):  
Guangjie Lv ◽  
Aili Li ◽  
Xincao Tao ◽  
Yanan Zhai ◽  
Yu Zhang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulmonary Artery ◽  
Influencing Factors ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Signal Quality ◽  
Limits Of Agreement ◽  
Right Heart

Abstract Purpose This study aimed to explore the accuracy and influencing factors of noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) with right heart catheterization (RHC) as reference. Methods A total of 218 highly suspected pulmonary hypertension (PH) patients who underwent RHC and echocardiography within 7 days were included. The ratio of (sPAPECHO-sPAPRHC)/sPAPRHC was calculated and divided into three groups, namely, the underestimation group, accurate group and overestimation group by ± 10% as the boundary. The correlation and consistency between tricuspid regurgitation (TR) derived parameters and RHC results were tested by Pearson and Bland-Altaman methods. With mPAP ≥ 25mmHg measured by RHC as the standard diagnostic criteria of PH, ROC curve was used to evaluate the diagnostic efficacy. The influencing factors of sPAPECHO were analyzed by ordered regression analysis. Results sPAPECHO had the greatest correlation coefficient (r = 0.781, P < 0.001) and best diagnostic efficiency (AUC = 0.98) compared with other TR related methods. Bland-Altman analysis demonstrated the bias of sPAPECHO (mean bias = 0.07mmHg, 95% limits of agreement: -32.08 to + 32.22mmHg) was lower than that of TR-PG (mean bias = 5.87mmHg, 95% limits of agreement: -26.46 to + 38.21mmHg). The results of ordered regression analysis showed that TR signal quality, PAWP and sPAPRHC level affected the accuracy of sPAPECHO (P < 0.05). Relative to the signal quality of type A, the OR value of type B and C signal quality were 0.26 (95%CI: 0.14, 0.48) and 0.23 (95%CI: 0.07, 0.73), respectively. The OR value of PAWP was 0.94 (95%CI: 0.89, 0.99). Compared with high sPAPRHC level, the OR value of low and medium sPAPRHC level were 21.56 (95%CI: 9.57, 48.55) and 5.13 (95%CI: 2.55, 10.32), respectively. Conclusion sPAPECHO was superior than other TR-related methods in screening PH. TR signal quality is vital for accurate assessment of sPAPECHO. For patients with pre-capillary disease, a higher echocardiographic threshold is more suitable for determining the possibility of PH, especially during the initial stage of disease.

scholarly journals Preoperative Evaluation of Pulmonary Hypertension in Lung Transplant Candidates: Echocardiography Versus Right Heart Catheterization

2021 ◽  
Author(s):  
Tal Abu ◽  
Amos Levi ◽  
David Hasdai ◽  
Mordechai R. Kramer ◽  
Tamir Bental ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background - Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary artery systolic pressure (PASP) assessment in lung transplantation (LT) candidates, although this is not mandated by current guidelines. We aimed to explore the correlation between PASP estimated by echocardiography to that measured by RHC, in this population in order to assess the necessity of RHC. Methods - From a retrospective registry of 393 LT candidates undergoing RHC and echocardiography during 2015-2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg, according to two methods – echocardiography and RHC. The primary outcome was the correlation between the PASP estimated by echocardiography to that measured by RHC. Secondary outcomes were the prediction value of the echocardiographic evaluation and its accuracy. Results - The mean value of PASP estimated by echocardiography was 49.5±20.0 mmHg, compared to 42.5±18.0 mmHg measured by RHC. The correlation between the two measurements was moderate (Pearson’s correlation: r=0.609, p<0.01). Echocardiography PASP measurements were moderately discriminative to diagnose PH, with an area under the curve (AUC) of 0.72 (95% CI 0.66-0.76). Echocardiographic overestimation of PASP of more than 10 mmHg was found in 35.0% of the patients, and underestimation was found in 11.6% of the patients.Conclusion - In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP had moderate correlation and limited accuracy compared to the PASP measured by RHC. We thus recommend performing routine RHC to all LT candidates, regardless of the echocardiographic estimation of PASP.

scholarly journals Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Skalsky ◽  
T Abu ◽  
A Levi ◽  
T Bental ◽  
R Hirsh ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Preoperative Evaluation ◽  
Systolic Pressure ◽  
Right Heart Catheterization ◽  
Mean Value ◽  
Secondary Outcome ◽  
Pulmonary Artery Systolic Pressure ◽  
Chronic Obstructive ◽  
Heart Catheterization ◽  
Right Heart

Abstract Background Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population. Methods From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH. Results Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p&lt;0.01). The accuracy of the echocardiographic estimation of PASP was poor with &gt;10 mmHg differences between the two values in 79.9% of the patients. Conclusions In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Pulmonary hypertension in patients with interstitial pneumonia with autoimmune features

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402094411
Author(s):  
Bashar N. Alzghoul ◽  
Robert Hamburger ◽  
Thomas Lewandowski ◽  
Brandon Janssen ◽  
Daniel Grey ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Regression Analysis ◽  
Interstitial Lung Disease ◽  
Right Ventricular ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Linear Regression Analysis ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart

Pulmonary hypertension in interstitial lung diseases is associated with increased mortality and hospitalizations and reduced exercise capacity. Interstitial pneumonia with autoimmune features (IPAF) is a recently described interstitial lung disease. The characteristics of pulmonary hypertension in IPAF patients are unknown. We sought to characterize patients with IPAF based on their echocardiographic probability of pulmonary hypertension and compare patients with and without pulmonary hypertension identified by right heart catheterization. We conducted a retrospective study of patients seen in the interstitial lung disease clinic from 2015 to 2018. Forty-seven patients with IPAF were identified. Patients were classified into low, intermediate and high echocardiographic pulmonary hypertension probabilities. A sub-group analysis of patients with pulmonary hypertension and without pulmonary hypertension (IPAF-PH vs. IPAF-no PH) identified by right heart catheterization was also performed. Linear regression analysis was performed to study the association between 6-min-walk-distance (6MWD) and pulmonary vascular resistance (PVR) while adjusting for age and body mass index. Right ventricular hypertrophy (>5 mm), right ventricular enlargement (>41 mm) and right ventricular systolic dysfunction defined as fractional area change% ≤35 was present in 76%, 24%, and 39% of patients, respectively. Pulmonary hypertension was identified in 12.7% of patients. IPAF-PH patients had higher mean pulmonary artery pressure and lower cardiac output compared to the IPAF-no PH group (34 mmHg vs. 19 mmHg, p = 0.002 and 4.0 vs. 5.7 L/min, p = 0.023, respectively). Lower 6MWD was associated with higher PVR on regression analysis ( p = 0.002). Pulmonologists should be aware that a significant number of IPAF patients may develop pulmonary hypertension. Reduced 6MWD may suggest the presence of pulmonary hypertension in IPAF patients.

scholarly journals Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension

2020 ◽  
Vol 10 (3) ◽  
pp. 204589402095022
Author(s):  
Anjali Vaidya ◽  
Jessica R. Golbus ◽  
Natasha A. Vedage ◽  
Jeremy Mazurek ◽  
Farhan Raza ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Screening Tool ◽  
Systolic Pressure ◽  
Area Under The Curve ◽  
Right Heart Catheterization ◽  
Discriminatory Power ◽  
Pulmonary Vascular Disease ◽  
Heart Catheterization ◽  
Right Heart ◽  
Tertiary Center

This study validated a novel virtual echocardiography screening tool (VEST), which utilized routinely reported echocardiography parameters to predict hemodynamic profiles in pulmonary hypertension (PH) and identify PH due to pulmonary vascular disease (PHPVD). Direct echocardiography imaging review has been shown to predict hemodynamic profiles in PH; however, routine use often overemphasizes Doppler-estimated pulmonary artery systolic pressure (PASPDE), which lacks discriminatory power among hemodynamically varied PH subgroups. In patients with PH of varying subtypes at a tertiary referral center, reported echocardiographic findings needed for VEST, including left atrial size, E:e’ and systolic interventricular septal flattening, were obtained. Receiver operating characteristic analyses assessed the predictive performance of VEST vs. PASPDE in identifying PHPVD, which was later confirmed by right heart catheterization. VEST demonstrated far superior discriminatory power than PASPDE in identifying PHPVD. A positive score was 80.0% sensitive and 75.6% specific for PHPVD with an area under the curve of 0.81. PASPDE exhibited poorer discriminatory power with an area under the curve of 0.56. VEST’s strong discriminatory ability remained unchanged when validated in a second cohort from another tertiary center. We demonstrated that this novel VEST using three routine parameters that can be easily extracted from standard echocardiographic reports can successfully capture PH patients with a high likelihood of PHPVD. During the Covid-19 pandemic, when right heart catheterization and timely access to experts at accredited PH centers may have limited widespread availability, this may assist physicians to rapidly and remotely evaluate PH patients to ensure timely and appropriate care.

scholarly journals Assessment of pulmonary artery hypertension by Doppler echocardiography and its correlation with right heart catheterization

2021 ◽  
Vol 8 (4) ◽  
pp. 523
Author(s):  
Vikrant B. Khese ◽  
Chandrakant B. Chavan ◽  
Ravi Kalra ◽  
Anirudh K. Allam ◽  
Abhinav Mohabey
Keyword(s):  
Pulmonary Artery ◽  
Systolic Pressure ◽  
Maximum Velocity ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Hypertension ◽  
Pulmonary Artery Systolic Pressure ◽  
Heart Catheterization ◽  
Right Heart ◽  
Number Of Patients ◽  
Pulmonary Arterial

Background: Definitive diagnosis of pulmonary artery hypertension (PH) requires an elevated mean pulmonary arterial pressure (MPAP) of 25 mmHg at rest measured by right heart catheterization (RHC). As it is invasive mode of investigation, it is declined by many patients, echocardiography was thought to be an acceptable substitute to assess pulmonary arterial pressures. Whether there is a correlation between these measurements is controversial. The aim of this study was to assess PH by echocardiography and its correlation with RHC.Methods: Twenty-six patients aged ≥18 years with pulmonary artery hypertension with or without tricuspid regurgitation (TR) were included in this cross-sectional study. All the patients underwent a transthoracic echocardiography evaluation and were taken for RHC study within an hour.Results: The correlation between pulmonary artery acceleration time (PAAT) and pulmonary artery systolic pressure (PASP) and PAAT and MPAP was significant in all degrees of PH. In contrast, correlation between TR jet maximum velocity (TR Vmax) derived estimated pulmonary artery systolic pressure (EPASP) and PASP was significant in moderate and severe PH, while it did not correlate in mild PH.Conclusions: PAAT is easily measurable parameter and strongly correlates with the values of PASP and the MPAP obtained by right heart catheterization. Implementation of a novel method of determining EPASP from PAAT shall increase significantly the number of patients in whom TTE can be used for the assessment of pulmonary hemodynamic non-invasively.

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