Detection of Pulmonary Hypertension with Systolic Pressure Estimated by Doppler Echocardiography

Sawada, Naruhiko; Kawata, Takayuki; Daimon, Masao; Nakao, Tomoko; Hatano, Masaru; Maki, Hisataka; Kimura, Kôichi; Hirokawa, Megumi; Ishiwata, Jumpei; Xu, Boqing; Yatomi, Yutaka; Komuro, Issei

doi:10.1536/ihj.18-453

Cited by 21 publications

(17 citation statements)

References 33 publications

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“…Our result supported this view in the opposite way. Pre-capillary PH patients with lower PAWP accounted for 85.8% of our population, and the optimal cut-off value of our cohort was 55.5 mmHg which is higher than previous studies focusing on postcapillary PH patients with higher PAWP [12,13] . We speculated the underestimation of sPAP ECHO due to high PAWP leads to lower sPAP ECHO threshold for post-capillary PH.…”

Section: Performance Of Spap Echo In Ph Screeningmentioning

confidence: 57%

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

Tao

et al. 2021

Preprint

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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.

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Section: Performance Of Spap Echo In Ph Screeningmentioning

confidence: 57%

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

Tao

et al. 2021

Preprint

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“…Third, we mainly used the TRPG-estimated pulmonary artery pressure on echocardiography for the diagnosis of PH, which may be less accurate than catheterization. However, since TRPG has been proven to be highly correlated with pulmonary artery systolic pressure [10], it is not expected to be a major problem in this study.…”

Section: Limitationsmentioning

confidence: 94%

“…We examined the results by dividing the patients into two groups: the group with postoperative PH (post-PH) and the group without postoperative PH (post-NPH). Post-PH was de ned as a patient with a tricuspid regurgitation pressure gradient (TRPG) >27 mmHg after surgery, with reference to three-quarters of 36 mmHg, which is the cutoff for TRPG in adult PH studies [10].…”

Section: Subjectsmentioning

confidence: 99%

Predicting Postoperative Hypertension Among Patients With Ventricular Septal Defect in Infants

Kawamura

Ueno

Shimozono

et al. 2021

Preprint

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Purpose: Patients with strong pulmonary vascular occlusive lesions are at risk of developing postoperative pulmonary hypertension (PH). We aimed to evaluate preoperative right ventricular (RV) function in patients with ventricular septal defect (VSD) who required cardiac surgery during infancy and consequently developed postoperative PH and to determine whether we could preliminarily evaluate postoperative PH in these patients.Methods: We retrospectively analyzed 55 infants with VSD who underwent cardiac surgery between March 2014 and April 2020. We evaluated the measurements of preoperative atrial/ventricular general function and 2D atrial/ventricular strain between these two groups: a group with postoperative PH (post-PH) and a group without postoperative PH (post-NPH). Results: Post-PH patients had a significantly lower tricuspid annular plane systolic excursion (TAPSE) (11.2 mm) and TAPSERA (the proportion of TAPSE due to RA contraction alone) (6.6 mm) than the post-NPH patients (14.1 mm, 8.5 mm). Furthermore, the post-PH group had a significantly lower peak right atrial (RA) longitudinal strain (PRALS) (31.0%) than the post-NPH group (43.0%). Multivariate logistic regression analysis identified that PRALS and TAPSERA were independent echocardiographic parameters for the presence of post-PH. The sensitivity and specificity of predicting post-PH for ≤38% of the PRALS were 83.0% and 100.0%, respectively, with an area under the curve of 0.94 (p < 0.01).Conclusion: Preoperative RA function and RV diastolic function decreased in the post-PH group. The RA strain and TAPSERA could be useful factors for predicting postoperative PH.

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“…Patients with left heart diseases (post-capillary) PH took up for 84% and 76% in these two researches, respectively [1,15] . This nding suggests that the best threshold of pre-capillary PH might be higher than post-capillary PH and PAWP may play an important role in it.…”

Section: Reasons For Inaccuracy Of Spap Echo Estimationmentioning

confidence: 99%

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

Tao

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

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Detection of Pulmonary Hypertension with Systolic Pressure Estimated by Doppler Echocardiography

Cited by 21 publications

References 33 publications

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

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

Predicting Postoperative Hypertension Among Patients With Ventricular Septal Defect in Infants

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

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