Key result
Echocardiographic pulmonary artery backward wave accurately detects elevated catheter PVR with an AUC of 0.91.
Why the study?
Existing non-invasive methods for measuring pulmonary vascular resistance are not sufficiently accurate for clinical practice.
Does a novel echocardiographic method of pulmonary artery wave reflection accurately estimate elevated pulmonary vascular resistance in patients with pulmonary hypertension compared to right heart catheterization?
Observational (n=83)
Does a novel echocardiographic method of pulmonary artery wave reflection accurately estimate elevated pulmonary vascular resistance in patients with pulmonary hypertension compared to right heart catheterization?
Effect estimate: r=0.77
p-value: p=<0.001
A novel echocardiographic method assessing pulmonary artery backward pressure provides a highly accurate, non-invasive estimation of elevated pulmonary vascular resistance.
May aid non-invasive PVR estimation in PH; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Several non-invasive methods for pulmonary vascular resistance (PVR) measurement are proposed, but none are sufficiently accurate for use in clinical practice. This study proposes a new echocardiographic method of pulmonary artery wave reflection and investigates its efficacy in managing patients with pulmonary hypertension. METHODS AND RESULTS: In total, 83 patients with left heart disease, pulmonary arterial hypertension, and chronic thromboembolic pulmonary hypertension (CTEPH), who underwent Doppler echocardiography and right heart catheterization, were included in the study. Pulmonary artery wave reflection was characterized by separating the pulmonary artery pressure waveform into forward and backward (Pb) waves, based on wave intensity. Pulmonary artery pressure waveforms were estimated from continuous Doppler tracings of tricuspid regurgitation velocity, and flow velocity was measured using pulsed Doppler of the right ventricular outflow tract. Pb-peak was compared with catheter hemodynamic indices, and with PVR by Abbas 2003, 2013 and Haddad in relation to increased catheter PVR. Catheter PVR and Pb were strongly correlated (r=0.77, P<0.001). The areas under the receiver operator characteristic curve for Pb-peak, PVR by Abbas 2003, 2013 and Haddad were 0.91, 0.72, 0.80, and 0.80, respectively, and were used to detect an increase in PVR (>3 Woods units). CONCLUSIONS: This study describes a novel, simple, and non-invasive echocardiography method to assess pulmonary wave reflected pressure to identify patients with pulmonary hypertension due to increased PVR.
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Hayama et al. (2021) conducted an observational in Pulmonary hypertension (n=83). Echocardiographic assessment of pulmonary artery wave reflection (Pb-peak) vs. Right heart catheterization and echocardiographic PVR by Abbas and Haddad was evaluated on Correlation between catheter PVR and Pb, and detection of increased PVR (>3 Woods units) (r=0.77, p=<0.001). Echocardiographic assessment of pulmonary artery backward wave (Pb-peak) strongly correlated with catheter PVR (r=0.77, P<0.001) and accurately detected elevated PVR with an AUC of 0.91.
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