Impact of Tricuspid Regurgitation Severity on Accuracy of Echocardiographic Estimation of Systolic Pulmonary Artery Pressure in Patients With Pulmonary Arterial Hypertension

Objective:This study aims to investigate the impact of tricuspid regurgitation(TR)severity on the accuracy of echocardiographic estimation of systolic pulmonary arterial pressure(sPAP)in patients with pulmonary arterial hypertension(PAH).Methods:Patients who were diagnosed with PAH and had a right heart catheterization(RHC)and echocardiography examination were selected retrospectively from May 2018 to December 2021.sPAP measured by RHC is used as the gold standard.A difference in sPAP of less than 10 mmHg between echocardiographic estimation by peak TR velocity and RHC measurement was defined as accurate,with a difference≥10 mmHg considered inaccurate.The factors affecting the accuracy of echocardiographic sPAP estimation were analyzed by univariate and multivariate analysis.Results:A total of 138 patients aged(45.57±15.97)years with PAH were enrolled.sPAP measured by echocardiography and RHC were(80.83±23.46)and(81.62±30.05)mmHg,respectively.The values of the 2 methods were highly correlated(r=0.809,P<0.01)and Bland-Altman plots showed good consistency.The accuracy rate of sPAP estimation by echocardiography was 42.03%(58/138).In the 57.97%(80/138)of patients where echocardiography was inaccurate,sPAP was overestimated in 28.26%(39/138)and underestimated in 29.71%(41/138).Univariate analysis showed that there was a statistically significant difference between the accurate and inaccurate groups in World Health Organization-Function Class,N-terminal pro-B-type natriuretic peptide,severity of TR,tricuspid annular plane systolic excursion(TAPSE),sPAP-RHC,mean pulmonary artery pressure,pulmonary vascular resistance(P<0.05).Multivariate logistic regression analyses identified the TR severity(odds ratio=2.292,95%confidence interval:1.126–4.667,P=0.022)and TAPSE(odds ratio=0.733,95%confidence interval:0.621–0.865,P<0.001)as independent predictors for the accuracy of echocardiographic sPAP estimation.Conclusion:Higher TR severity and lower TAPSE values reduce the accuracy of sPAP estimated by echocardiography.Therefore,TR severity and right heart function should be considered when echocardiography is used to estimate sPAP by the TR velocity.

Qualitative estimation of pulmonary artery systolic pressure:could right heart catheterization be replaced by transthoracic Doppler echocardiography?

Background Transthoracic Doppler echocardiography is recommended for screening the presence of pulmonary hypertension(PH).However,the accuracy of pulmonary artery systolic pressure(PASP) estimated by Doppler echocardiographic is still unknown.Methods We conducted a retrospective study on 102 patients with idiopathic pulmonary arterial hypertension who underwent Doppler echocar-diography within 72 hours before right heart catheterization. During this time,all patients were stable without any specific drug therapy.Results There was moderate correlation between Doppler echocardiographic and right heart catheteriza- tion measurements of PASP(r =0.642,P【0.001).Using Bland-Altman analytic methods,the bias for the echocardio-graphic estimates of PASP was 6.65 mm Hg with 95%limits of agreement ranging from -47.62 to 34.30 mm Hg.There were 58.8%cases with absolute differences over 10 mm Hg between the two methods.Overestimation and underestimation of PASP by Doppler echocardiography occurred in 15.7% (16/102) and 43.1%(44),respectively.The magnitude of pressure underestimation and overestimation was insignificant (24.52±12.15 vs.25.69±16.09,P=0.765),while the corresponding diagnostic categories of severity that each subject would fall into for each technique are not in good agreement. The diagnostic categories of 16 overestimated patients were in accordance.During 44 underestimated patients,20.5%of patients had their pressure underestimated within one diagnostic category(minor error);4.5%of the underestimates were with two diagnostic categories(major error).Conclusions Transthoracic Doppler echocardiography may frequently be inaccurate in estimating PASP and could not replace the right heart catheterization.

Correlation analysis between lung ultrasound scores and pulmonary arterial systolic pressure in patients with acute heart failure admitted to the emergency intensive care unit

Background:No convenient,inexpensive,and non-invasive screening tools exist to identify pulmonary hypertension(PH)-left heart disease(LHD)patients during the early stages of the disease course.This study investigated whether different methods of lung ultrasound(LUS)could be used for the initial investigation of PH-LHD.Methods:This was a single-center prospective observational study which was performed in the Zigong Fourth People’s Hospital.We consecutively enrolled patients with heart failure(HF)admitted to the emergency intensive care unit from January 2018 to May 2020.Transthoracic echocardiography and LUS were performed within 24 h before discharge.We used the Spearman coefficient for correlation analysis between ultrasound scores and pulmonary arterial systolic pressure(PASP).Bland-Altman plots were generated to inspect possible bias,and receiver operating characteristic(ROC)curves were calculated to assess the relationship between ultrasound scores and an intermediate and high echocardiographic probability of PH-LHD.Results:Seventy-one patients were enrolled in this study,with an overall median age of 79(interquartile range:71.5–84.0)years.Among the 71 patients,36(50.7%)cases were male,and 26(36.6%)had an intermediate and high echocardiographic probability of PH.All four LUS scores in patients with an intermediate and high probability of PH were significantly higher than in patients with a low probability of PH(P<0.05).The correlation coefficient(r)between different LUS scoring methods and PASP was moderate for the 6-zone(r=0.455,P<0.001),8-zone(r=0.385,P=0.001),12-zone(r=0.587,P<0.001),and 28-zone(r=0.535,P<0.001)methods.In Bland-Altman plots,each of the four LUS scoring methods had a good agreement with PASP(P<0.001).The 8-zone and 12-zone methods showed moderately accurate discriminative values in differentiating patients with an intermediate and high echocardiographic probability of PH(P<0.05).

Prognostic implications of elevated pulmonary artery systolic pressure on 6-month mortality in elderly patients with acute myocardial infarction

Background:Pulmonary artery systolic pressure(PASP)has often been evaluated as an indicator of heart failure,but the relationship between PASP and the prognosis of elderly patients with acute myocardial infarction(AMI)is not well understood.Methods:The medical data of 3460 hospitalized elderly patients diagnosed with AMI between January 2013 and June 2018 were reviewed.PASP was calculated usingtransthoracic color Doppler ultrasonography.Patients were grouped accordingtotheir admission PASP results as follows:Group A,PASP≤30 mmHg;Group B,30 mmHg<PASP≤50 mmHg;and Group C,PASP≥51 mmHg.The primary endpoint was all-cause death 6 months following AMI.Multiple Cox regression analysis was used to identify independent risk factors for 6-month mortality in elderly patients with AMI.Results:PASP was associated with age,Killip classification,AMI site,and decreased ejection fraction in elderly patients.After adjusting for clinical and echocardiographic parameters in the Cox model,PASP was found to be significantly related to all-cause mortality.In receiver operating characteristic analysis,a PASP of>34 mmHg had a sensitivity of 62.3%and specificity of 65.7%for predicting 6-month all-cause death after AMI.Conclusion:PASP at admission is a useful marker for predicting short-term mortality in elderly patients with AMI.This finding could be used to help identify high-risk patients and make appropriate clinical decisions.