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Accuracy and diagnostic performance of doppler echocardiography to estimate mean pulmonary artery pressure in heart failure.
Björkman, Alva; Lund, Lars H; Faxén, Ulrika Ljung; Lindquist, Per; Venkateshvaran, Ashwin.
Afiliación
  • Björkman A; Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.
  • Lund LH; Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.
  • Faxén UL; Department of Medicine, Cardiology Unit, Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden.
  • Lindquist P; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
  • Venkateshvaran A; Department of Clinical Physiology, Surgical & Perioperative sciences, Umeå University, Umeå, Sweden.
Echocardiography ; 38(9): 1624-1631, 2021 09.
Article en En | MEDLINE | ID: mdl-34510533
BACKGROUND: Multiple echocardiographic algorithms have been proposed to estimate mean pulmonary artery pressure (PAPM ) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of four echocardiographic approaches to estimate PAPM in heart failure (HF) patients undergoing near-simultaneous right heart catheterization (RHC), and compared diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRVmax ). METHODS: We employed four validated echocardiographic algorithms incorporating tricuspid regurgitation peak or mean gradient, pulmonary regurgitation peak gradient, and right ventricular outflow tract acceleration time to estimate PAPM . Echocardiographic estimates of right atrial pressure were incorporated in all algorithms but one. Association and agreement with invasive PAPM were assessed. Diagnostic performance of all algorithms to identify PH was evaluated and compared with the recommended TRVmax cut-off. RESULTS: In 112 HF patients, all echocardiographic algorithms demonstrated reasonable association (r = .41-.65; p < 0.001) and good agreement with invasive PAPM , with relatively lower mean bias and higher precision observed in algorithms that incorporated tricuspid regurgitation peak or mean gradient. All methods demonstrated strong ability to identify PH (AUC = .70-.80; p < 0.001) but did not outperform TRVmax (AUC = .84; p < 0.001). Echocardiographic estimates of right atrial pressure were falsely elevated in 30% of patients. CONCLUSIONS: Echocardiographic estimates demonstrate reasonable association with invasive PAPM and strong ability to identify PH in HF. However, none of the algorithms outperformed recommendation-advised TRVmax . The incremental value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Tricúspide / Insuficiencia Cardíaca / Hipertensión Pulmonar Tipo de estudio: Diagnostic_studies / Guideline Límite: Humans Idioma: En Revista: Echocardiography Asunto de la revista: CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2021 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Tricúspide / Insuficiencia Cardíaca / Hipertensión Pulmonar Tipo de estudio: Diagnostic_studies / Guideline Límite: Humans Idioma: En Revista: Echocardiography Asunto de la revista: CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2021 Tipo del documento: Article País de afiliación: Suecia Pais de publicación: Estados Unidos