January 1, 2023The Anatolian Journal of CardiologyOpen Access

Reappraisal of the Transthoracic Echocardiographic Algorithm in Predicting Pulmonary Hypertension Redefined by Updated Pulmonary Artery Mean Pressure Threshold

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Why the study?

The reliability of the echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings remained to be determined for the updated hemodynamic definition of pulmonary hypertension.

Does the transthoracic echocardiographic algorithm accurately predict pulmonary hypertension defined by the updated threshold of mPAP > 20 mm Hg compared to mPAP ≥ 25 mm Hg in patients undergoing right heart catheterization?

Structured PICO

Population

1,300 patients (mean age 53.1 ± 18.8 years, 62.1% female) who underwent right heart catheterization with different indications between 2006 and 2018.

Intervention

Transthoracic echocardiographic algorithm based on tricuspid regurgitation jet peak velocity (TRVmax) and suggestive findings for pulmonary hypertension

Comparator

Right heart catheterization (invasive hemodynamic measurement of mean pulmonary arterial pressure)

Outcome

Probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and ≥ 25 mm Hgsurrogate

The updated pulmonary hypertension threshold of mPAP > 20 mm Hg reduces the predictive value of suggestive echocardiographic findings, making non-invasive diagnosis more reliant on tricuspid regurgitation peak velocity alone.

Limitations

Retrospective study design
Hemodynamic data were not always obtained on the same day as the echocardiographic examination
Data regarding pulmonary regurgitation flow rate could not be obtained clearly and was excluded

Implication

First retrospective data on echo algorithm for updated PH definition; leaves open need for prospective validation before clinical use.

Abstract

BACKGROUND: Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively. METHODS: Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines. RESULTS: Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P <.001) and 1.25 (0.86-1.82, P =.16), respectively. In predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, tricuspid regurgitation jet peak velocity, and suggestive findings showed an odds ratio of 2.33 (1.80-3.04, P <.001) and 1.54 (1.15-2.08, P <.001), respectively. The tricuspid regurgitation jet peak velocity > 2.8 m/s and tricuspid regurgitation jet peak velocity > 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively. CONCLUSIONS: In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies.