Author + information
- Jared O'Leary,
- Tufik Assad,
- Meng Xu,
- Eric Farber-Eger,
- Quinn Wells and
- Evan Brittain
Background: Pulmonary hypertension (PH) is a common clinical problem. Transthoracic echocardiography (TTE) is used to estimate pulmonary arterial pressure (PAP), but an adequate tricuspid regurgitation velocity (TRV) needed to calculate PAP is not always present. It is unknown whether the absence of a measurable TRV signifies normal PAP.
Methods: We extracted hemodynamic, TTE, and clinical data from Vanderbilt's de-identified electronic medical record in all patients referred for right heart catheterization (RHC) between 1998-2014. PH was defined as mean PAP (mPAP) ≥ 25mmHg.
Results: We identified 1,262 patients who had a TTE within 2 days of RHC. In total 803/1,262 (64%) had a reported TRV whereas 459 (36%) had no reported TRV. Among those with no TRV, 91% were described as having no or trace tricuspid regurgitation, 6% mild, 1% moderate and 2% severe. Invasively confirmed PH was present in 47% of patients without a reported TRV versus 68% in those with a reported TRV (Figure 1; p < 0.001). Absence of a TRV yielded a negative predictive value for excluding PH of only 53%. The mPAP in patients with and without a TRV was 33±14mmHg and 26±11mmHg respectively (p<0.001); however, 19% of the no TRV group had a mPAP ≥35mmHg. The pulmonary artery wedge pressure was >15mmHg in 74% of patients with no TRV and PH.
Conclusions: PH is present in almost half of patients without a reported TRV on TTE who are also referred for RHC. Clinicians should use caution when making assumptions about PH status in the absence of a measurable TRV on TTE.
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: 1100-008
- 2017 American College of Cardiology Foundation