August 6, 2025Open Access
Assessing the accuracy of echocardiographic estimation of pulmonary pressures: Insights from a 5-grade tricuspid regurgitation classification
Key Result
Echocardiographic RVSP estimation strongly correlated with invasive RVSP in TR grades 1-4 (R=0.70-0.87, p<0.001), but correlation was only moderate in torrential TR grade 5 (R=0.57).
Study Design
Type
Observational (n=454)
Structured PICO
Does echocardiographic RVSP estimation accurately reflect invasive RVSP across different grades of tricuspid regurgitation severity?
P
Population
454 patients who underwent same-day transthoracic echocardiography (TTE) and right heart catheterization (RHC), with tricuspid regurgitation (TR) severity graded 1 to 5.
I
Intervention
Echocardiographic right ventricular systolic pressure (eRVSP) estimation
C
Comparator
Invasive RVSP (iRVSP) via right heart catheterization
O
Outcome
Agreement between eRVSP and iRVSP across the five-grade TR severity classificationsurrogate
Echocardiographic RVSP estimation is accurate for ruling out pulmonary hypertension in TR grades 1-4, but its sensitivity decreases in torrential TR (grade 5), requiring a lower threshold for detection.
Main Result
Effect estimate: R = 0.70-0.87
p-value: p=<0.001
Abstract
BACKGROUND: The accuracy of echocardiographic right ventricular systolic pressure (eRVSP) estimation may be compromised in the context of severe tricuspid regurgitation (TR). This study assessed the agreement between eRVSP and invasive RVSP (iRVSP) using the five-grade TR severity classification. METHODS: 742 patients who underwent same-day transthoracic echocardiography (TTE) and right heart catheterization (RHC) we retrospectively screened. TR severity was graded from 1 to 5; all patients with TR grades 3-5 were referred for TEE-R screening. RESULTS: The final cohort included 454 patients. eRVSP and iRVSP demonstrated strong correlations in TR grades 1-4 (R = 0.70-0.87; all p 60 mmHg (AUC = 0.93). CONCLUSION: eRVSP provides reliable rule-out information for PH across TR grades 1-4. In torrential TR, the low sensitivity might be improved by applying a lower threshold may improve sensitivity. Importantly, eRVSP effectively identifies PH at thresholds relevant for excluding TEE-R eligibility.