Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae

Abstract

Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP − 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech-Hanssen (0.65 × PASP − 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland–Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.

Is the maternal risk of pregnancy acceptable in patients with moderate pulmonary hypertension?

“…RHC measurement, regardless of the underlying pathology(8). Thus, in concordance with the latest guidelines from the European Society of Cardiology and European…”

“… 7 On the other hand, there is a poor agreement between echocardiographic mean PAP estimates (four tricuspid regurgitation jet-derived) and RHC measurement, regardless of the underlying pathology. 8 Thus, in concordance with the latest guidelines from the European Society of Cardiology and European Respiratory Society, TTE should only be used as the first-line screening modality. 5 With improvements in the echocardiographic evaluation of the right ventricular function, TTE has become a valuable tool in the follow-up of patients.…”

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

“…Thus, our data suggest that when PA pressure can be measured by echocardiography, this is an effective screening tool for detecting patients at risk for mild PH who may benefit from further evaluation, close follow‐up, and risk reduction interventions 17, 20. Nonetheless, a recent study in patients with PH (mPAP >25 mm Hg) demonstrated modest correlation and poor agreement between echocardiography‐derived and RHC‐measured PASP and mPAP 28. Fisher et al29 showed that approximately half of the cases of PASP overestimation are related solely to right atrial pressure overestimation by echocardiography.…”

Echocardiographic Assessment of the Right Ventricle–State of the Art

“…Right ventricular systolic pressure and pulmonary artery (PA) systolic pressure are equal in the absence of right ventricular outflow obstruction and pulmonary stenosis [26]. The mean PA pressure can be derived from echocardiographic measurement of the systolic pulmonary artery pressure [27] and the diastolic pulmonary artery pressure [7] or from PA acceleration time [28], however there is substantial potential for error. Echocardiography can also be used to calculate pulmonary vascular resistance, using the TR-jet and RVOT time-velocity integral (TVI) [29], but lacks accuracy, particularly for serial assessment [30].…”