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Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension.

Hammerstingl C, Schueler R, Bors L, Momcilovic D, Pabst S, Nickenig G, Skowasch D - PLoS ONE (2012)

Bottom Line: Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r=0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r=0.43, P<0.001).Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P=0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P=0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥-8.4%).TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine II, Cardiology/Pneumology, University of Bonn, Bonn, Germany.

ABSTRACT

Aims: To determine the value of echocardiography including tissue Doppler imaging (TDI) and right ventricular (RV) speckle tracking analysis for the diagnosis of pulmonary hypertension (PH) and discrimination between pre- and postcapillary PH.

Methods and results: 155 consecutive patients (mean age 70.5±13.0 years, 81 [52%] male gender, BMI 27.2±6.1 kg/m(2)) with PH undergoing right heart catheterization (RHC) and transthoracic echocardiography (TTE) with TDI between January 2008 and December 2009 were retrospectively evaluated including offline speckle tracking analysis of RV contractility. After RHC 23.2% of patients (36) were diagnosed with precapillary PH. Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r=0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r=0.43, P<0.001). Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P=0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P=0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥-8.4%). TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.

Conclusion: Echocardiography allows feasible and reliable estimation of PH and seems helpful to distinguish between pre-and postcapillary PH. Further prospective studies on patients with different manifestations of PH must validate the predictive value of echocardiography in this clinical setting.

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Patient distribution according to results of right heart catheterization; flow chart of the study design.PH, postcapillary pulmonary hypertension; RHC, right heart catheterization; TTE, transthoracic echocardiography; sPAP, systolic pulmonary arterial pressure; RVaSl, apical right ventricular longitudinal strain.
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pone-0038519-g002: Patient distribution according to results of right heart catheterization; flow chart of the study design.PH, postcapillary pulmonary hypertension; RHC, right heart catheterization; TTE, transthoracic echocardiography; sPAP, systolic pulmonary arterial pressure; RVaSl, apical right ventricular longitudinal strain.

Mentions: Figure 2 shows a flow chart of our study concept. Consecutive patients with suspected PH undergoing standardized two dimensional TTE ≤7 days before RHC were retrospectively analysed. Based on the invasive hemodynamic evaluation during RHC, precapillary or postcapillary PH was diagnosed according to current guidelines [3]. Patients with significant valvular heart disease and cardiomyopathies of any aetiology were excluded from the analysis. Precapillary PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg and pulmonary capillary wedge pressure (PCWP) of ≤15 mmHg; patients with an Mpap ≥25 mmHg and a PCWP >15 mmHg were defined as suffering from postcapillary PH.


Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension.

Hammerstingl C, Schueler R, Bors L, Momcilovic D, Pabst S, Nickenig G, Skowasch D - PLoS ONE (2012)

Patient distribution according to results of right heart catheterization; flow chart of the study design.PH, postcapillary pulmonary hypertension; RHC, right heart catheterization; TTE, transthoracic echocardiography; sPAP, systolic pulmonary arterial pressure; RVaSl, apical right ventricular longitudinal strain.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369879&req=5

pone-0038519-g002: Patient distribution according to results of right heart catheterization; flow chart of the study design.PH, postcapillary pulmonary hypertension; RHC, right heart catheterization; TTE, transthoracic echocardiography; sPAP, systolic pulmonary arterial pressure; RVaSl, apical right ventricular longitudinal strain.
Mentions: Figure 2 shows a flow chart of our study concept. Consecutive patients with suspected PH undergoing standardized two dimensional TTE ≤7 days before RHC were retrospectively analysed. Based on the invasive hemodynamic evaluation during RHC, precapillary or postcapillary PH was diagnosed according to current guidelines [3]. Patients with significant valvular heart disease and cardiomyopathies of any aetiology were excluded from the analysis. Precapillary PH was defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg and pulmonary capillary wedge pressure (PCWP) of ≤15 mmHg; patients with an Mpap ≥25 mmHg and a PCWP >15 mmHg were defined as suffering from postcapillary PH.

Bottom Line: Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r=0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r=0.43, P<0.001).Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P=0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P=0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥-8.4%).TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine II, Cardiology/Pneumology, University of Bonn, Bonn, Germany.

ABSTRACT

Aims: To determine the value of echocardiography including tissue Doppler imaging (TDI) and right ventricular (RV) speckle tracking analysis for the diagnosis of pulmonary hypertension (PH) and discrimination between pre- and postcapillary PH.

Methods and results: 155 consecutive patients (mean age 70.5±13.0 years, 81 [52%] male gender, BMI 27.2±6.1 kg/m(2)) with PH undergoing right heart catheterization (RHC) and transthoracic echocardiography (TTE) with TDI between January 2008 and December 2009 were retrospectively evaluated including offline speckle tracking analysis of RV contractility. After RHC 23.2% of patients (36) were diagnosed with precapillary PH. Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r=0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r=0.43, P<0.001). Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P=0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P=0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥-8.4%). TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.

Conclusion: Echocardiography allows feasible and reliable estimation of PH and seems helpful to distinguish between pre-and postcapillary PH. Further prospective studies on patients with different manifestations of PH must validate the predictive value of echocardiography in this clinical setting.

Show MeSH
Related in: MedlinePlus