Accuracy of echocardiographic hemodynamic assessment compared to right heart catheterization: results from the TECH prospective multicentric registry

Background Recent evidence has demonstrated that transthoracic echocardiography (TTE) can reliably estimate several hemodynamic parameters obtained via right heart catheterization (RHC), paving the way for the so-called "echodynamic approach." Nevertheless, robust prospective validation of this methodology remains lacking. Methods We used data from the TECH registry (Testing Echocardiography vs. Catheterization in Hemodynamics), an ongoing prospective, multicentric registry designed to evaluate the accuracy of echocardiographic hemodynamic assessment against invasive measurements obtained via RHC. All patients underwent RHC and TTE within 6 hours under the same hemodynamic conditions. Pearson correlation coefficients and Bland-Altman analysis were used to assess the accuracy between invasive and echocardiographic estimates of systolic pulmonary artery pressure (sPAP), cardiac output (CO), right atrial pressure (RAP), and pulmonary arterial wedge pressure (PAWP). Results A total of 167 patients were included (mean age 69 ± 15 years; 47% female). sPAP showed the strongest agreement between RHC and TTE (r=0.86, 95% CI 0.82–0.90; n=163), with a mean bias of −1.84 mmHg (LoA −13.20 to +9.52 mmHg). CO estimated by LVOT pulsed-wave Doppler correlated moderately with thermodilution-derived CO (r=0.72, 95% CI 0.63–0.79; n=152), with a mean bias of −0.02 L/min (LoA −2.41 to +2.37 L/min). RAP, estimated by IVC variability, showed acceptable correlation (r=0.59, 95% CI 0.48–0.68; n=163), with wider limits of agreement (LoA −8.03 to +9.70 mmHg). The agreement between invasive PAWP and E/e′ was the weakest across all comparisons (r=0.48, 95% CI 0.33–0.61; n=122), with broad limits of agreement (LoA −7.94 to +12.09 mmHg). Conclusions In a contemporary, prospective, multicentric large cohort undergoing simultaneous RHC and TTE, the echodynamic approach demonstrated overall good accuracy across key hemodynamic parameters, with excellent accuracy for sPAP and clinically acceptable accuracy for CO. These results provide robust prospective evidence supporting the integration of echocardiographic hemodynamic assessment into routine clinical practice, potentially reducing the need for invasive procedures in selected patients. Further refinement of echocardiographic surrogates for PAWP and RAP estimation represents a key target for future research in this field.