Author + information
- Tim Seidlera,b,
- Kristian Hellenkampa,b,
- Bernhard Unsölda,b,
- Sitali Mushemi-Blakea,b,
- Ajay Shaha,b and
- Gerd Hasenfussa,b
Background: Current guidelines advise the use of echocardiography to non-invasively estimate the likelihood of pulmonary hypertension (PH) in patients. The maximal tricuspid regurgitation velocity (TRVmax) is recommended as the main parameter to use in assessing the echocardiographic probability of PH, over algorithms based on the use of additional parameters that provide an estimation of pulmonary artery pressure (PAP). This preference is based on concerns of inaccuracies and amplification of measurement errors by using derived variables. However, this has not been examined systematically.
Methods: We undertook a retrospective database analysis of invasively determined measurements of right heart pressures during right heart catheterization and echocardiographic estimations of PAP and additional parameters in three university hospitals in Europe. Several algorithms were compared for their correlation and additional parameters of accuracy including ROC analysis.
Results: Algorithms estimating mean PAP (PAPm) based on tricuspid regurgitation exhibited higher correlation with invasively determined PAPm and a more accurate prediction of PH compared to the use of TRVmax. Echocardiographic estimation of right atrial pressure (RAP) >15mmHg exhibited the highest odds ratio for the presence of invasively confirmed PH, suggesting that this parameter is of additional diagnostic value. Indeed, those algorithms that also considered RAP performed best, whereas empirical algorithms, TRVmax and methods relying on pulmonary acceleration time exhibited weaker performance.
Conclusions: Echocardiographically determined PAPm was superior to the current guideline recommendation of TRVmax with regard to the correlation with invasively determined PAPm and the prediction of PH. PAPm should be considered as an alternative to TRVmax for assigning the echocardiographic probability of PH.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Imaging Pulmonary Vascular Disease Plus the Impact of Congenital Heart Disease
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1100-006
- 2017 American College of Cardiology Foundation