Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis

Abstract

Summary Rationale Pulmonary hypertension (PH) commonly complicates the course of patients with idiopathic pulmonary fibrosis (IPF). It has a significant impact on outcomes and is, therefore, important to detect. Objectives We sought to characterize the accuracy and performance characteristics of the right ventricular systolic pressure (RVSP) as estimated by echocardiography (ECHO) alone and in conjunction with physiologic indices in predicting the presence of PH in IPF patients. Methods Cross-sectional study of IPF patients from two large tertiary centers in whom both ECHO and right-heart catheterization (RHC) were available. Measurements and main results There were 110 patients with available ECHOs and RHCs. Estimates of RVSP were reported in 60 of these patients (54.5%) of whom 22 (36.6%) had PH, while 16 of the 50 patients without RVSP estimate (32%) had PH. Twenty-four of 60 (40%) ECHOs accurately reflected the pulmonary arterial systolic pressure as measured by RHC. An optimal RVSP threshold for the screening of PH could not be detected. When assessed in combination with various thresholds of PFT and 6-minute walk test (6MWT) parameters, the performance characteristics of the RVSP were slightly improved. Conclusion The RVSP is not an accurate test for the assessment of PH in IPF patients. Awareness of the various combinations of threshold values for RVSP with and without PFT and 6MWT might nonetheless assist clinicians in risk stratifying IPF patients for the presence of PH.

Pulmonary Hypertension in the Course of Diffuse Parenchymal Lung Diseases—State of Art and Future Considerations

“…al. in IPF patients; RVSP > 50 mm Hg had 50% sensitivity, 68% specificity, 45% PPV and 72% NPV for the recognition of PH [47].…”

“…Nevertheless, the diagnostic value of echocardiography in DPLDs is uncertain. The comparison between echocardiographic measures and the parameters obtained on RHC in the patients with lung diseases revealed the discordant results (both underestimation and overestimation) in 50−60% of patients [46,47]. The optimal RVSP cut off value predictive for PH could not be found by Nathan et.…”

Echocardiography as an Outcome Measure in Scleroderma-related Pulmonary Arterial Hypertension: A Systematic Literature Analysis by the EPOSS Group

“…However, it needs to be emphasized that other echo parameters might be more relevant for certain aspects of PAH-SSc than PASP alone. For instance, as shown in patients with severe idiopathic PAH, reduction in PASP may reflect disease progression and right-ventricle failure rather than improvement of PAH [49]. In …”

Practical approach to screening for scleroderma‐associated pulmonary arterial hypertension

“…Another limitation of echocardiography is that up to 15% of patients do not have a visible TR jet, thereby not allowing for RVSP estimation. Echocardiography both under-and overestimates PH in scleroderma and becomes less accurate when there is advanced parenchymal lung disease (47,51). Finally, although the echocardiogram can provide an excellent noninvasive assessment of the current status of the right side of the heart, RVSP elevation (unlike the DLCO) has not been shown to be a risk factor for future development of SSc-PAH (9).…”