Key result
Heart rate-adjusted PAAcT and RVSmVTI accurately predicted pulmonary hypertension (AUC 0.96 and 0.93, respectively) and elevated pulmonary vascular resistance in patients with COPD.
Why the study?
Do echocardiographic indices (RVSmVTI and PAAcT) accurately predict pulmonary hypertension and elevated pulmonary vascular resistance in outpatients with COPD?
Observational (n=100)
Do echocardiographic indices (RVSmVTI and PAAcT) accurately predict pulmonary hypertension and elevated pulmonary vascular resistance in outpatients with COPD?
Effect estimate: AUC 0.93 for RVSmVTI and 0.96 for PAAcT
Novel echocardiographic indices (RVSmVTI and PAAcT) offer a highly feasible and accurate non-invasive method to detect pulmonary hypertension and elevated pulmonary vascular resistance in COPD patients.
May support noninvasive PH screening in COPD outpatients; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities. METHODS: Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPD patients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50). RESULTS: PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively. CONCLUSIONS: Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPD patients.
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Hilde et al. (2016) conducted an observational in Chronic obstructive pulmonary disease (COPD) (n=100). Echocardiographic indices (heart rate adjusted-PAAcT and RVSmVTI) vs. Right heart catheterization was evaluated on Prediction of pulmonary hypertension (mPAP ≥ 25mmHg) and elevated PVR ≥ 2WU (AUC 0.93 for RVSmVTI and 0.96 for PAAcT). Heart rate-adjusted PAAcT and RVSmVTI accurately predicted pulmonary hypertension (AUC 0.96 and 0.93, respectively) and elevated pulmonary vascular resistance in patients with COPD.
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