The accuracy and influencing factors of Doppler echocardiography in estimating pulmonary artery systolic pressure: comparison with right heart catheterization: a retrospective cross-sectional study

Abstract

Background Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH), but there is still a high proportion of overestimation or underestimation of sPAPECHO. We therefore aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as a reference. Methods A total of 218 highly suspected PH patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR)-related methods and RHC results were tested by Pearson and Bland–Altman methods. TR-related methods included peak velocity of TR (TR Vmax), TR pressure gradient (TR-PG), TR mean pressure gradient (TR-mPG), estimated mean pulmonary artery pressure (mPAPECHO), and sPAPECHO. With mPAP ≥ 25 mm Hg measured by RHC as the standard diagnostic criterion of PH, the ROC curve was used to compare the diagnostic efficacy of sPAPECHO with other TR-derived parameters. The ratio (sPAPECHO–sPAPRHC)/sPAPRHC was calculated and divided into three groups as follows: patients with an estimation error between − 10% and + 10% were defined as the accurate group; patients with an estimated difference greater than + 10% were classified as the overestimated group; and patients with an estimation error greater than − 10% were classified as the underestimated group. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis. Results sPAPECHO had the highest correlation coefficient (r = 0.781, P < 0.001), best diagnostic efficiency (AUC = 0.98), and lowest bias (mean bias = 0.07 mm Hg; 95% limits of agreement, − 32.08 to + 32.22 mm Hg) compared with other TR-related methods. Ordinal regression analysis showed that TR signal quality, sPAPRHC level, and pulmonary artery wedge pressure (PAWP) affected the accuracy of sPAPECHO (P < 0.05). Relative to the good signal quality, the OR values of medium and poor signal quality were 0.26 (95% CI: 0.14, 0.48) and 0.23 (95% CI: 0.07, 0.73), respectively. Compared with high sPAPRHC level, the OR values of low and medium sPAPRHC levels were 21.56 (95% CI: 9.57, 48.55) and 5.13 (95% CI: 2.55, 10.32), respectively. The OR value of PAWP was 0.94 (95% CI: 0.89, 0.99). TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO. Conclusions In this study, we found that all TR-related methods, including sPAPECHO, had comparable and good efficiency in PH screening. To make the assessment of sPAPECHO more accurate, attention should be paid to TR signal quality, sPAPRHC level, and PAWP.

Prevalence and risk prediction value of tricuspid regurgitation by echocardiography in precapillary pulmonary hypertension

“…In our previous study [ 2 ], Bland–Altman analysis demonstrated low bias between RHC and TR-derived parameters with wide limits of agreements. In our patients, TR-sPAP ECHO in Moderate TR group had the greatest correlation coefficient with mPAP RHC (0.742, p < 0.001) followed by Mild TR group (0.635, p < 0.001) and severe group (0.592, p = 0.033).…”

“…Peak velocity of TR (TR Vmax) and its derived parameters systolic and mean pulmonary artery pressure (PAP) by Doppler echocardiography (sPAP ECHO and mPAP ECHO ) are most commonly used for assessing PH. We previously investigated the accuracy and impact factors of TR in estimating PAP and have demonstrated sPAP ECHO was superior than other TR-related methods in screening PH [ 2 ]. However, in precapillary PH, the true incidence of TR and the distribution of different TR degree are still poorly defined.…”

Automatic echocardiographic evaluation of the probability of pulmonary hypertension using machine learning

“…However, there have been a number of earlier studies that indicate that echocardiographic estimates of PA pressure are frequently inaccurate 6,7 . The estimated error ranged from −20 to +25 mmHg compared to data from RHC 8–10 . This was mainly contributed to the morphological variation of reflux flow and reflux caliber, and right ventricular volume load and systolic function, intra‐ and interexaminer variability, and other factors 11 .…”

“…6,7 The estimated error ranged from −20 to +25 mmHg compared to data from RHC. [8][9][10] This was mainly contributed to the morphological variation of reflux flow and reflux caliber, and right ventricular volume load and systolic function, intra-and interexaminer variability, and other factors. 11 On the other hand, using the estimated pressure alone is not sufficient to diagnose PH.…”

A Nomogram for Predicting the Risk of Pulmonary Hypertension for Patients with Chronic Obstructive Pulmonary Disease

“… 9 Compared to RHC, echocardiography has been shown to be a reliable method in several studies. 10 , 11 In the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension, echocardiography is the preferred non-invasive test for PH screening and follow-up; the guidelines also recommend that it should be used to screen for PH in patients whose clinical data suggest an increased risk of PH. 12…”