Key result
TRG > 46 mmHg yields ~95% PPV for the new pulmonary hypertension definition.
Why the study?
Invasively diagnosed PH was recently redefined as mPAP > 20 mmHg instead of ≥ 25 mmHg, creating a need to investigate the ability of echocardiographic TRG thresholds to screen for this new definition.
Does echocardiographic tricuspid regurgitation gradient accurately screen for the new definition of pulmonary hypertension (mPAP > 20 mmHg) in patients with suspected PH?
Observational (n=1,572)
No
Does echocardiographic tricuspid regurgitation gradient accurately screen for the new definition of pulmonary hypertension (mPAP > 20 mmHg) in patients with suspected PH?
Lowering the echocardiographic TRG cut-off to ≤ 31 mmHg to screen for the new definition of pulmonary hypertension worsens positive predictive value, suggesting higher thresholds or combined parameters are needed.
Answers are grounded in this paper and cite their sources.
Caution against lowering TRG threshold for new PH definition; extends echo screening data but needs prospective validation.
BACKGROUND: Currently an echocardiographic threshold for the tricuspid regurgitation gradient (TRG) of > 31 mmHg is recommended for screening for pulmonary hypertension (PH). Invasively diagnosed PH was recently redefined as mean pulmonary arterial pressure (mPAP) > 20 mmHg instead of ≥ 25 mmHg. We investigated the ability of TRG to screen for the new PH-definition. METHODS: Retrospective assessment of echocardiography and right heart catheterisation data from 1572 patients entering the Giessen PH-Registry during 2008-2018. Accuracy of different TRG thresholds and other echocardiographic parameters was evaluated using receiver operating characteristic curves. FINDINGS: 1264 patients fulfilled the new PH-definition. Positive (PPV) and negative predictive values and accuracy of TRG > 46 mmHg were 95%, 39%, and 73%, respectively, for the new PH-definition. Lowering the TRG cut-off to 31 mmHg and below worsened PPV to ≤ 89%. The PPV of TRG for pre-capillary PH (mPAP > 20 mmHg and pulmonary vascular resistance ≥ 3 Wood Units) was ≤ 85%. In patients with TRG ≤ 46 mmHg, tricuspid annular plane systolic excursion/TRG and TRG/right ventricular outflow tract acceleration time were superior to TRG in screening for newly defined pre-capillary PH. INTERPRETATION: In patients with suspected PH referred to a tertiary care centre, the PPV of TRG to meet the new PH-definition depended strongly on the TRG cut-off used. Our data do not support lowering the TRG cut-off. Combining TRG with other echocardiographic parameters might improve the validity of echocardiographic screening for PH.
No takes yet. Share an insight, caveat, or question.
Gall et al. (2021) conducted an observational in Pulmonary hypertension (n=1,572). Echocardiographic tricuspid regurgitation gradient (TRG) vs. Right heart catheterisation was evaluated on Accuracy of different TRG thresholds for the new PH-definition (mPAP > 20 mmHg). An echocardiographic tricuspid regurgitation gradient > 46 mmHg yielded a 95% positive predictive value for the new pulmonary hypertension definition, and lowering the cut-off worsened the PPV.
Synapse has enriched 10 related papers. Consider them for comparative context: