Predictive value of simple echocardiographic parameters for screening pulmonary hypertension under the revised definition: a study for general hospitals

Figures

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  Figure 1. Flow chart of the study population. Flow diagram illustrating patient selection at Okayama University Hospital and Kure Kyosai Hospital. Of 1714 patients initially identified, 755 patients were included in the final analysis. mPAP, mean pulmonary arterial pressure; RHC, right heart catheterisation; TRV, tricuspid regurgitation velocity.

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  Figure 2. Correlation between pulmonary arterial pressures and peak TRV. Scatter plots demonstrate the association between peak TRV and (A) mean PAP and (B) systolic PAP, with significant correlations (r=0.73 and r=0.79; p<0.001 and p<0.001, respectively). PAP, pulmonary arterial pressure; TRV, tricuspid regurgitation velocity.

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  Figure 3. Restricted cubic spline curve for peak TRV and PH risk. Restricted cubic spline curve showed the adjusted OR (blue line) and 95% CI (blue shades) for PH according to peak TRV (peak TRV 1.8 m/s as the reference value (OR=1.0)), with a non-linear association between peak TRV and PH. A steep increase of PH risk at peak TRV of 2.7 m/s was observed (OR 2.12, 95% CI 1.09–4.13). PH, pulmonary hypertension; TRV, tricuspid regurgitation velocity.

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  Figure 4. ROC curve analysis of different cut-off values of peak TRV and eRAP for screening PH. ROC curve of peak TRV and PH diagnosis shows the c-statistic (area under the curve) of 0.82 (95% CI 0.79 to 0.85) (A). Comparison of ROC curves between peak TRV alone and in combination with eRAP for PH diagnosis (B). The combined model yielded a higher c-statistic (0.83, 95% CI 0.80 to 0.86) than TRV alone (0.80, 95% CI 0.77 to 0.84), with a net reclassification improvement of 0.14 and a significant difference by DeLong test (p=0.002). eRAP, estimated right atrial pressure; PH, pulmonary hypertension; ROC, receiver-operating characteristic; TRV, tricuspid regurgitation velocity.

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  Figure 5. Association between eRAP and PH risk. (A) ORs for PH across eRAP categories of 5–10 mm Hg and 10–20 mm Hg compared with 0–5 mm Hg as the reference. The odds of PH were 3.67 (95% CI 2.55 to 5.32) at 5–10 mm Hg and 5.18 (95% CI 2.54 to 11.4) at 10–20 mm Hg, indicating a higher risk of PH, particularly at eRAP ≥5 mm Hg. (B) Cross-categorisation table shows the association of peak TRV and eRAP with PH risk. Each cell presents the OR and 95% CI. The cells are highlighted depending on the OR (≤1.00, white; 1.01–10.0, yellow; 10.1–20.0, orange and ≥20.1, red). The subgroup with eRAP ≥5 mm Hg and peak TRV ≥2.7 m/s showed the highest risk of PH (OR 28.5, 95% CI 16.1 to 53.2). eRAP, estimated right atrial pressure; PH, pulmonary hypertension; TRV, tricuspid regurgitation velocity.