Accuracy and Diagnostic Performance of Doppler Echocardiography to Estimate Mean Pulmonary Artery Pressure in Heart Failure
BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAP) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAP in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRV). METHODS. PAP was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAP were assessed. Diagnostic performance of DE methods vs. TRV=2.8m/sec to identify invasive PAP ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAP, with relatively lower mean bias and higher precision observed in algorithms that included TRV or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRV (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAP demonstrate reasonable accuracy to represent invasive PAP and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRV. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.