Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension

Kathleen Broderick-Forsgren, Clemontina A. Davenport, Joseph A. Sivak, Charles William Hargett, Michael C. Foster, Andrew Monteagudo, Alicia Armour, Sudarshan Rajagopal, Kristine Arges, Eric J. Velazquez, Zainab Samad

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC = 0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.

Original languageEnglish
Pages (from-to)1341-1349
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Volume33
Issue number9
DOIs
Publication statusPublished - 1 Sept 2017
Externally publishedYes

Keywords

  • Diagnostic characteristics
  • Echocardiogram
  • Pulmonary hypertension
  • Right ventricular systolic pressure (RVSP)

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