Diagnostic Accuracy of Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-analysis

Janda, Surinder; Shahidi, Neal; Gin, Kenneth; Swiston, John R.

doi:10.1378/chest.9930

Cited by 83 publications

(112 citation statements)

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“…1,4- 8 The merits of both methods are often compared, especially for the estimation of systolic pulmonary artery pressure (SPAP). 9 However, SPAP does not describe all of the hemodynamic parameters involved in the progression and prognosis of PH. Other hemodynamic parameters have also been separately validated for ECHO using various equations, in animal and human studies and under different clinical conditions (including PH).…”

Section: Methodsmentioning

confidence: 99%

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Doutreleau

Canuet

Enache

et al. 2016

Circ J

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Section: Methodsmentioning

confidence: 99%

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Doutreleau

Canuet

Enache

et al. 2016

Circ J

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“…(Bossone et al , 2005, Currie et al , 1985 Among the echocardiographic parameters for estimating pulmonary arterial pressure (PAP), tricuspid valve regurgitation velocity (TRV) is widely used; however, a recent meta-analysis showed that its sensitivity and specificity for estimating pulmonary arterial pressure were only 83% and 72%, respectively. (Janda et al , 2011) Although several other Doppler imaging-based methods have been proposed to estimate PAP, none of them has yet eliminated the need for invasive evaluation. (Chemla et al , 2009, Gurudevan et al , 2007, Lang et al , 2010, Vlahos et al , 2008 Recent advances in echocardiography have allowed quantification of regional and global myocardial function.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

et al. 2014

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Aims: Echocardiography is widely used for screening of pulmonary hypertension (PH). More recently developed two-dimensional speckle-tracking echocardiography (2D-STE) can assess regional deformation of the myocardium and is useful for detecting left ventricular dysfunction. However, its usefulness to assess right ventricular (RV) dysfunction is not clear. Therefore, the aim of this study was to investigate the ability of peak systolic strain (PSS) and post-systolic strain index (PSI) at the RV free wall determined by 2D-STE to detect PH.Main methods: Thirty-six images (27 images from PH patients, nine from patients with connective tissue disease without PH) obtained by 2D-STE were analysed. We investigated the relationship between RV hemodynamics measured by right heart catheterization and PSS, PSI and other echocardiographic parameters reflecting RV overload including RV end-diastolic diameter (RVDd) and tricuspid valve regurgitant pressure gradient (TRPG).Key findings: PSS, PSI, RVDd and TRPG were all correlated with mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR). Furthermore, when PSS and MPAP were measured twice, the change in PSS was correlated with the change in MPAP (r=0.633, p=0.037). Multivariate logistic regression analysis identified PSS as the only independent factor associated with MPAP≥35 mmHg [odds ratio (OR), 1.616; 95% confidence interval (CI) 1.017-2.567; p=0.042] and PVR≥400 dyne·sec·cm -5 (OR, 1.804; 95% CI 1.131-2.877; p=0.013). Furthermore, the optimal PSS cut-off value to detect an elevated MPAP and PVR was -20.75%, based on receiver operating characteristic curve analysis.Significance: PSS of the RV free wall might serve as a useful non-invasive 2 indicator of PH.

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“…Also, we used the modified Bernoulli equation that includes a fixed 10 mm Hg estimate for the RAP. Assuming a fixed RAP of 10 mm Hg had been shown to be less reproducible than alternative methods of estimating the RAP by echocardiography such as using the diameter and collapse of the inferior vena cava during spontaneous respiration (25,26). Finally, since the competing risk of death, treatment failure, or renal transplantation were not incorporated into the Cox proportional hazards regression model, use of a competing-risks (Fine-Gray) survival model to estimate mortality may lead to less bias.…”

Section: Discussionmentioning

confidence: 99%

Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

Xu¹,

Xiong²,

Fan³

et al. 2015

Perit Dial Int

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♦ Background: The prognostic value of pulmonary hypertension at the start of peritoneal dialysis (PD) in patient survival is unclear. ♦ Methods: We conducted a retrospective study of incident patients who initiated PD therapy from January 2007 to December 2011, and followed up through June 2013. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure (PAP) of ≥ 35 mm Hg using echocardiography. Clinical parameters and laboratory findings were compared between patients with and without pulmonary hypertension and a logistic regression model was elaborated. Patient outcomes (all-cause and cardiovascular mortality) were recorded during follow-up. Survival curves were constructed by the Kaplan-Meier method, and the influences of pulmonary hypertension on outcomes were analyzed by Cox regression models. .1% of them due to cardiovascular disease. Kaplan-Meier survival analysis showed that patients with pulmonary hypertension had worse overall rates of survival and cardiovascular death-free survival than those without pulmonary hypertension. After multivariate adjustment, pulmonary hypertension was independently associated with increased risk for both all-cause and cardiovascular mortality, with hazard ratios (HRs) of 2.10 (95% CI: 1.35 -3.27) and 2.60 (95% CI: 1.48 -4.56), respectively. ♦ Conclusions: The prevalence of pulmonary hypertension at the start of PD was common and associated with increased risk of both all-cause and cardiovascular mortality in incident PD patients. KEY WORDS: End-stage renal disease; peritoneal dialysis; pulmonary hypertension; survival. P ulmonary hypertension is a devastating disorder, characterized by a progressive increase in pulmonary vascular resistance and pulmonary artery pressure (PAP), leading to right heart failure or even death (1,2). Recently, pulmonary hypertension has been increasingly recognized as a novel threat in patients with end-stage renal disease (ESRD), with an estimated prevalence range of 0 -68.8% (3-7). The mechanisms involved in pulmonary hypertension development are still under investigation. However, it has been suggested that some factors responsible for this pathogenesis include pulmonary artery calcifications secondary to hyperparathyroidism, volume overload, severe anemia, hemodynamic modifications due to the size or the location of an arteriovenous fistula, and exposure to dialysis membranes. In contrast, pulmonary hypertension improves after successful kidney transplantation (8).Previous studies have demonstrated that pulmonary hypertension, either pre-existing before initiating hemodialysis (HD) or developing incident after regular HD treatment, is related to increased mortality rates (5,7,9). Further, enhanced PAP has a poor survival rate extending to a period beyond dialysis. In a study regarding renal transplant recipients, severe pulmonary hypertension, defined as mean PAP > 50 mmHg, conferred a hazard ratio (HR) of 3.75 (95% confidence

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Diagnostic Accuracy of Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-analysis

Cited by 83 publications

References 0 publications

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

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Diagnostic Accuracy of Echocardiography for Pulmonary Hypertension: A Systematic Review and Meta-analysis

Cited by 83 publications

References 0 publications

Right Heart Hemodynamics in Pulmonary Hypertension – An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension – An Echocardiography and Catheterization Study –

Longitudinal strain of right ventricular free wall by 2-dimensional speckle-tracking echocardiography is useful for detecting pulmonary hypertension

Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

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Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –

Right Heart Hemodynamics in Pulmonary Hypertension　– An Echocardiography and Catheterization Study –