Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension

Abstract

This study validated a novel virtual echocardiography screening tool (VEST), which utilized routinely reported echocardiography parameters to predict hemodynamic profiles in pulmonary hypertension (PH) and identify PH due to pulmonary vascular disease (PHPVD). Direct echocardiography imaging review has been shown to predict hemodynamic profiles in PH; however, routine use often overemphasizes Doppler-estimated pulmonary artery systolic pressure (PASPDE), which lacks discriminatory power among hemodynamically varied PH subgroups. In patients with PH of varying subtypes at a tertiary referral center, reported echocardiographic findings needed for VEST, including left atrial size, E:e’ and systolic interventricular septal flattening, were obtained. Receiver operating characteristic analyses assessed the predictive performance of VEST vs. PASPDE in identifying PHPVD, which was later confirmed by right heart catheterization. VEST demonstrated far superior discriminatory power than PASPDE in identifying PHPVD. A positive score was 80.0% sensitive and 75.6% specific for PHPVD with an area under the curve of 0.81. PASPDE exhibited poorer discriminatory power with an area under the curve of 0.56. VEST’s strong discriminatory ability remained unchanged when validated in a second cohort from another tertiary center. We demonstrated that this novel VEST using three routine parameters that can be easily extracted from standard echocardiographic reports can successfully capture PH patients with a high likelihood of PHPVD. During the Covid-19 pandemic, when right heart catheterization and timely access to experts at accredited PH centers may have limited widespread availability, this may assist physicians to rapidly and remotely evaluate PH patients to ensure timely and appropriate care.

Distinguishing exercise intolerance in early‐stage pulmonary hypertension with invasive exercise hemodynamics: Rest VE/VCO2 and ETCO2 identify pulmonary vascular disease

“…All PVD with exercise subjects were started on PH vasodilator therapy, while none of the PVH or NCD subjects was offered PH therapy. 8 , 17 , 18 , 19 , 20 , 21 …”

“…Moreover, in patients unable to undergo a maximal exercise test and who would benefit from an ambulatory test to identify PVD, the role of gas exchange parameters at rest needs to be explored. 18 , 19 …”

“…Moreover, in patients unable to undergo a maximal exercise test and who would benefit from an ambulatory test to identify PVD, the role of gas exchange parameters at rest needs to be explored. 18,19 In this study, we report on the invasive exercise cardiopulmonary hemodynamics and simultaneous expired gas analysis from a broad cohort of subjects with exercise intolerance and dyspnea (suspected due to PH at rest and/or with exercise). Our goal is to identify significant patterns of gas exchange parameters among different phenotypes of subjects with dyspnea and improve upon noninvasive rest diagnostic tools for early identification of PVD.…”

“…While early diagnosis of PH and predominant phenotype of PH can be established with exercise invasive hemodynamics 11–14 and simultaneous expired gas analysis (cardiopulmonary exercise testing: CPET) at expert centers, 15–17 the noninvasive CPET facilities are more widely available. Moreover, in patients unable to undergo a maximal exercise test and who would benefit from an ambulatory test to identify PVD, the role of gas exchange parameters at rest needs to be explored 18,19 …”

Correlation of echocardiographic probability of pulmonary hypertension with maternal outcomes in pregnant women with elevated right ventricular systolic pressure

“…1 However, similar to the general population, the majority of patients had structural heart disease or clinical features consistent with PH due to left heart disease. 4,10 Further noninvasive methods of classifying PH subgroups have been described 16,17 and could potentially be applied to pregnant women with elevated RVSP to help determine the need for invasive hemodynamic assessment.…”