What Echocardiography Can Reliably Tell Us About Our Pulmonary Hypertension Patients

Abstract

Pulmonary hypertension (PH) is a complex, multi-organ system disease that is broadly defined by an elevation in pulmonary artery pressures. There are key biologic differences in the pathophysiology among the different PH subgroups that warrant a targeted approach to clinical care of these patients. The complex geometry of and wide array of clinical tools to assess the right heart in PH add another layer of complexity in patient care. Echocardiography can be used as a powerful tool to discriminate among the subgroups of PH, a critical first step in evaluating a new case of PH. In this article, we will explore novel approaches using echocardiography that go beyond simply estimating pulmonary pressures and provide a readily accessible means of adding diagnostic and prognostic accuracy in the clinical setting.

Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension

“…Our data are in line with a growing body of literature that integration of selected, often easily obtainable echocardiographic variables can provide powerful insight into the hemodynamic basis of PH. 6,20,22,23 Our data extend these observations further, given that the VEST utilizes routinely reported echocardiographic variables, thus obviating the need for direct image analysis or echocardiographic expertise to apply. As such, VEST enhances the prompt diagnostic abilities of physicians engaged in the growing paradigm of telemedicine and virtual patient assessment in the Covid-19 era.…”

“…The use of echocardiography to predict hemodynamic profiles in PH has otherwise been previously described. 3,6,16–25 While RHC remains the gold standard for diagnosis of PH, we demonstrated previously that a scoring system based on left atrial (LA) size, transmitral and tissue Doppler E:e’ ratio, and the presence of at least one of two abnormal measurements (AccT or profile notching) from the pulsed wave (PW) Doppler of the RVOT had an area under the curve (AUC) of 0.904 for prediction of PH PVD . 23 In the same study, PASP DE , which is often used to screen for the presence of PH, had a much smaller AUC equal to 0.689.…”

“…1,4,5 These poor survival rates in PAH are known to be associated with right ventricular (RV) dilatation and dysfunction. [6][7][8] The gold standard to diagnose PH is right heart catheterization (RHC) which allows for hemodynamic ''phenotyping'' of the different PH subgroups, a critical first step in evaluation of a patient with newly suspected PH. 3 The coronavirus disease-19 or Covid-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was first reported in Wuhan, China in December 2019.…”

“…In contrast to PH LHD , PH due to pulmonary vascular disease (PH PVD ; defined as the presence of PH with pulmonary capillary wedge pressure (PCWP) ≤15 mmHg and pulmonary vascular resistance (PVR) > 3 Wood Units (WU), which encompasses WHO group I or pulmonary arterial hypertension (PAH), is associated with poor survival rates and must be promptly diagnosed and treated with PH‐specific medications 1 , 4 , 5 . These poor survival rates in PAH are known to be associated with right ventricular (RV) dilatation and dysfunction 6–8 . The gold standard to diagnose PH is right heart catheterization (RHC) which allows for hemodynamic “phenotyping” of the different PH subgroups, a critical first step in evaluation of a patient with newly suspected PH 3 …”

“…Applicability of these guidelines rely on expert echocardiographic assessment of direct imaging, and do not support making a distinction between PH PVD and PH LHD . The use of echocardiography to predict hemodynamic profiles in PH has otherwise been previously described 3 , 6 , 16–25 . While RHC remains the gold standard for diagnosis of PH, we demonstrated previously that a scoring system based on left atrial (LA) size, transmitral and tissue Doppler E:e’ ratio, and the presence of at least one of two abnormal measurements (AccT or profile notching) from the pulsed wave (PW) Doppler of the RVOT had an area under the curve (AUC) of 0.904 for prediction of PH PVD 23 .…”