The role of echocardiography in the diagnosis and management of patients with pulmonary hypertension

Abstract

Pulmonary hypertension (PH) is defined as an increased mean pulmonary artery pressure (Ppa) .25 mmHg at rest as assessed by right heart catheterisation (RHC). However, this technique is invasive and noninvasive alternatives are desirable for early diagnosis of PH. Although estimation of systolic pulmonary arterial pressure is easily obtained using Doppler echocardiography, cases of under-and over-estimations are not rare and direct measurement of Ppa is not possible using this method. Therefore, echocardiography should be considered as a tool for assessment of the likelihood rather than the definite presence or absence of PH. Transthoracic echocardiography may be useful for noninvasive screening of patients at risk of PH. On the basis of an echocardiographic assessment, patients showing signs suggestive of PH can be referred for a confirmatory RHC. A number of variables measured during echocardiography reflect the morphological and functional consequences of PH and have prognostic value. The presence of pericardial effusion, reduced tricuspid annular plane excursion and right atrial enlargement are associated with a poorer prognosis. Echocardiography is also an important procedure for monitoring the response of patients to therapy, and is recommended 3-4 months after initiation of, or a change in, therapy. Echocardiographic assessment as part of a goal-oriented approach to therapy is essential for the effective management of PH patients.

Transthoracic Echocardiography in the Evaluation of Pediatric Pulmonary Hypertension and Ventricular Dysfunction

“…An RA area > 20 cm 2 has been shown to be abnormal, and an RA area > 27 cm 2 showed a higher rate of death in adults with IPAH. 110,111 In adult patients with chronic PAH, the RA size significantly increases and parallels signs of activation of the Frank-Starling mechanism in both right chambers. The RA size has been shown to be positively related to larger RV dimensions.…”

Subjective assessment of right ventricle enlargement from computed tomography pulmonary angiography images

“…In keeping with current literature that does not include echocardiography [8,10,16,27], our main goal was to compare accuracy among different strategies to evaluate the RV using CTPA data and thus incorporating findings from echocardiography would not have changed the conclusions. We acknowledge that RV size is not always an optimal metric for adverse outcomes and that echocardiographic measures of RV function such as Tricuspid Annular Plane Systolic Excursion (TAPSE) [28] are rapid and accepted as important indices for clinical management decisions. Further investigation incorporating subjective RV enlargement and measured RV function would potentially improve our modest results for specificity.…”

Severe pulmonary arterial hypertension secondary to lupus in the emergency department: proactive intense care associated with a better short‐term survival

“…10 Echocardiography, which by no means substitutes the 'gold standard' right heart catheterization, may facilitate the identification, triage and prompt initiation of intensive treatment for such severe SLE-PAH patients in a timely manner. From the perspective of preventive care, screening and pick-up of SLE-PAH as soon as possible is paramount, which will largely reduce or at least retard the occurrence of such emergency events.…”

“…The inclusion criteria were: (i) fulfillment of the American College of Rheumatology classification criteria for SLE; 8 (ii) PAH defined by Doppler echocardiograph with estimated systolic pulmonary artery pressure > 50 mmHg; 9,10 and (iii) with WHO functional class of III or IV. Patients with pulmonary hypertension caused by left heart dysfunction, thromboembolism and/or interstitial lung disease were ruled out by left ventricular ejection fraction (LVEF) > 0.55 or pulmonary computed tomography scan, which largely guaranteed the enrollment of Group 1 PAH.…”