Transthoracic echocardiography estimation of sPAP showed good overall concordance with right heart catheterization (LCC 0.80) but was weaker in severe tricuspid regurgitation (LCC 0.67).
Observational (n=236)
No
Does transthoracic echocardiography reliably estimate systolic pulmonary artery pressure compared to right heart catheterisation in patients with severe tricuspid regurgitation?
Transthoracic echocardiography may underestimate systolic pulmonary artery pressure in patients with severe tricuspid regurgitation, particularly in the presence of elevated right atrial pressure or a V-wave cut-off sign.
Effect estimate: LCC 0.80 (95% CI 0.74-0.84)
OBJECTIVES: The estimation of systolic pulmonary artery pressure (sPAP) by transthoracic echocardiography (TTE) is challenging in patients with severe tricuspid regurgitation (TR). The study aimed to determine the reliability of the assessment of sPAP by TTE in this population. METHODS: This study was a single-centre analysis of consecutive patients at the University Hospital of Rennes with right heart catheterisation and TTE, performed with a maximum delay of 48 hours. Lin's concordance coefficient (LCC) and Bland-Altman analysis were used to compare the values. RESULTS: After applying the exclusion criteria, 236 patients were included in the analysis (age 71±11.5 years old; male 56%). The two principal indications were TR (34.3%) and mitral regurgitation (32.2%). The correlation between the two procedures was good in the total population (LCC=0.80; 95% limits of agreement (LOA): 0.74, 0.84), but weaker in the 78 patients (33%) with severe TR (LCC=0.67; 95% LOA: 0.49, 0.80), with a propensity to an underestimation by TTE. An elevated right atrial pressure (RAP) was associated with an underestimation by TTE of about 8 mmHg. The presence of a 'V-wave cut-off' sign on continuous-wave Doppler (OR=3.74; 95% CI 1.48, 9.30; p<0.01), found exclusively in patients with severe TR, was an independent predictor of sPAP misestimation by TTE. CONCLUSION: The reliability of the estimation of sPAP in patients with severe TR could be altered by high RAP which cannot be estimated with current thresholds.
Lemarchand et al. (Thu,) conducted a observational in severe tricuspid regurgitation (n=236). Transthoracic echocardiography (TTE) vs. Right heart catheterisation was evaluated on Concordance of systolic pulmonary artery pressure (sPAP) estimation between TTE and right heart catheterisation (LCC 0.80, 95% CI 0.74-0.84). Transthoracic echocardiography estimation of sPAP showed good overall concordance with right heart catheterization (LCC 0.80) but was weaker in severe tricuspid regurgitation (LCC 0.67).