ePLAR - The echocardiographic pulmonary to left atrial ratio - a novel non-invasive parameter to differentiate pre-capillary and post-capillary pulmonary hypertension

Scalia, G.; Scalia, I.; Kierle, R.; Beaumont, Rebekka; Cross, D.; Feenstra, John; Burstow, D.; Fitzgerald, B.; Platts, D.

doi:10.1016/j.hlc.2015.06.535

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…PAOP pulmonary artery occlusion pressure pre-capillary and combined pre-and post-capillary PH than in isolated post-capillary PH [14]. ePLAR (echocardiographic pulmonary-to-left atrial ratio using tricuspid regurgitant velocity and E/e′) appears to be a simple, non-invasive ratio in differentiating pre-and post-capillary PH with reasonable accuracy, albeit in non-critically ill cohorts [15] (Fig. 4).…”

Section: Lap and 'Rv-pulmonary Circuit' Dysfunctionmentioning

confidence: 95%

Bedside assessment of left atrial pressure in critical care: a multifaceted gem

Bowcock

McLean

2022

Crit Care

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Evaluating left atrial pressure (LAP) solely from the left ventricular preload perspective is a restrained approach. Accurate assessment of LAP is particularly relevant when pulmonary congestion and/or right heart dysfunction are present since it is the pressure most closely related to pulmonary venous pressure and thus pulmonary haemodynamic load. Amalgamation of LAP measurement into assessment of the ‘transpulmonary circuit’ may have a particular role in differentiating cardiac failure phenotypes in critical care. Most of the literature in this area involves cardiology patients, and gaps of knowledge in application to the bedside of the critically ill patient remain significant. Explored in this review is an overview of left atrial physiology, invasive and non-invasive methods of LAP measurement and their potential clinical application. Graphical abstract

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Section: Lap and 'Rv-pulmonary Circuit' Dysfunctionmentioning

confidence: 95%

Bedside assessment of left atrial pressure in critical care: a multifaceted gem

Bowcock

McLean

2022

Crit Care

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“…We also estimated the discrimination ability of a non‐invasive PVR > 3 and an ePLAR ≥ 40 (the cut‐offs were chosen based on previously published findings 9 and after testing for different ones) to predict precapillary PH.…”

Section: Methodsmentioning

confidence: 99%

“…In order to improve the differentiation between PH-HFpEF and precapillary PH, several groups had developed predicting non-invasive parameters (such as non-invasive PVR estimated from the ratio between peak tricuspid regurgitation velocity (TRV) or estimated pulmonary artery systolic pressure (PASP) and the time-velocity integral of the right ventricular outflow tract (TVI RVOT) 7,8 and echocardiographic pulmonary to left atrial ratio (ePLAR) 9 ) and scores that incorporate both clinical and echocardiographic features. [10][11][12][13][14] A critical aspect of any clinical prediction model is its external validity.…”

Section: Introductionmentioning

confidence: 99%

External validation of different clinical and echocardiographic scores to distinguish post‐ from precapillary pulmonary hypertension

Oliveira¹,

Oliveira

Furtado³

et al. 2021

Echocardiography

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Background: Even though right heart catheterization (RHC) is the gold-standard method to characterise Pulmonary Hypertension (PH), it cannot be performed in all the patients with suspected PH. Clinical and echocardiographic scores have been developed to differentiate PH secondary to heart failure with preserved ejection fraction (PH-HFpEF) from pre-capillary PH. We aimed to compare the performance of noninvasive parameters in a population with suspected PH. Methods:We retrospectively included consecutive patients who underwent RHC for suspected PH. Patients with a non-invasive evaluation clearly suggestive of left heart disease were excluded. We assessed the performance of non-invasive pulmonary vascular resistance (PVR), echocardiographic pulmonary to left atrial ratio (ePLAR), and Opotowsky, Richter, Berthelot, and D'Alto scores using the area under curve (AUC) of the receiver operating characteristic curves.Results: Of the 142 included patients, 61 patients had pre-capillary PH, 49 had PH-HFpEF, and 32 patients did not meet invasive criteria for PH. We were able to perform the aforementioned scores in 71-100% of our patients. Using the original cut-offs, Opotowsky was the score that best predicted precapillary PH (96% sensitivity, 41% specificity, AUC .69), followed by D'Alto (98% sensitivity, 22% specificity, AUC .60) and Berthelot (32% sensitivity, 90% specificity, AUC .60). Richter score did not discriminate between phenotypes (AUC .50). Using optimised cut-offs, a Berthelot score < 9 predicted precapillary PH with 73% sensitivity and 74% specificity (AUC .73). Single echocardiographic parameters as non-invasive PVR (85% sensitivity, 59% specificity, AUC .72) and ePLAR (73% sensitivity, 76% specificity, AUC .75) showed better prediction performance than the composite studied scores. Conclusion:Combined clinical and echocardiographic characteristics can be used to predict pre-capillary PH with moderate performance. The application of these noninvasive parameters in clinical practice can help refine referral to RHC in a population with clinically suspected PH.

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“…Recently the echocardiographic pulmonary to left atrial ratio (ePLAR) has been proposed as a simple measure to help differentiate patients with elevated pulmonary vascular resistance from those with pulmonary hypertension due to left heart disease [30]. This index is calculated from the ratio of the peak tricuspid regurgitation velocity and the E/E'.…”

Section: Left Heart Diseasementioning

confidence: 99%