Key result
The novel echocardiographic index mPAPEcho / LVIDd ≥ 1.14 demonstrated an 80.0% sensitivity and 74.7% specificity (AUC 0.840) for identifying markedly elevated pulmonary vascular resistance (>15 WU).
Why the study?
Most echocardiographic methods for estimating pulmonary vascular resistance in pulmonary hypertension have focused on relatively low resistance, leaving the evaluation of markedly elevated pulmonary vascular resistance unclear.
Does the echocardiographic index mPAPEcho / LVIDd accurately estimate markedly elevated PVR (>15 WU) in patients with pre-capillary pulmonary hypertension?
Observational (n=129)
No
Does the echocardiographic index mPAPEcho / LVIDd accurately estimate markedly elevated PVR (>15 WU) in patients with pre-capillary pulmonary hypertension?
Effect estimate: AUC 0.840 (95% CI 0.76-0.92)
Absolute Event Rate: 0.84% vs 0.772%
p-value: p=<0.0001
The novel echocardiographic index mPAPEcho / LVIDd provides a simple, noninvasive method to estimate markedly elevated PVR (>15 WU) in patients with pre-capillary pulmonary hypertension.
May aid noninvasive identification of high PVR in pre-capillary PH; leaves open prospective validation before clinical adoption.
Background: Several echocardiographic methods to estimate pulmonary vascular resistance (PVR) in patients with pulmonary hypertension (PH) have been proposed. So far, most studies have focused on relatively low PVR. We aimed to clarify the clinical usefulness of our new echocardiographic index of evaluating markedly elevated PVR in pre-capillary PH patients. Methods: We studied 129 consecutive patients with pre-capillary PH. We estimated the mean pulmonary artery pressure using echocardiography (mPAPEcho) and measured LV internal diameter at end diastole (LVIDd). The ratio of mPAPEcho / LVIDd was then correlated with invasive PVR. Using receiver operating characteristic curve analysis, a cutoff value for the index was generated to identify patients with PVR > 15 Wood units (WU). Results: mPAPEcho / LVIDd correlated well with PVR (r = 0.70, P < 0.0001). There was a better correlation between PVR and mPAPEcho / LVIDd in patients with PVR > 15 WU compared with TRV2 /TVIRVOT and sPAPEcho / LVIDd. A cut-off value of 1.14 had an 80.0% sensitivity and 74.7% specificity to determine PVR > 15 WU (AUC=0.840, p<0.0001). Conclusions: The index of mPAPEcho / LVIDd could be a valuable noninvasive and simple method of estimating markedly elevated PVR in pre-capillary PH patients.
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Zhai et al. (2021) conducted an observational in Pre-capillary Pulmonary Hypertension (n=129). mPAPEcho / LVIDd index vs. TRV2 / TVIRVOT and sPAPEcho / LVIDd was evaluated on Determination of PVR > 15 Wood units (AUC 0.840, 95% CI 0.76-0.92, p=<0.0001). The novel echocardiographic index mPAPEcho / LVIDd ≥ 1.14 demonstrated an 80.0% sensitivity and 74.7% specificity (AUC 0.840) for identifying markedly elevated pulmonary vascular resistance (>15 WU).
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