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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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Related in: MedlinePlus

Right ventricular speckle tracking and 3 dimensional visualisation of longitudinal right ventricular strain values.Right ventricular; 3D, three dimensional; RVSl, right ventricular longitudinal strain.
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pone-0038519-g003: Right ventricular speckle tracking and 3 dimensional visualisation of longitudinal right ventricular strain values.Right ventricular; 3D, three dimensional; RVSl, right ventricular longitudinal strain.

Mentions: Figure 3 shows an example of RV ST analysis of RV deformation capabilities. Two cine loops from apical four chamber view were digitized and stored on an echocardiographic imaging server (XCELERA, Philips Medical Systems, Koninklijke N.V.). Offline 2D ST analyses of the gray scale images obtained by 2D echocardiography were done by using commercially available software (TomTec Imaging Systems GmbH, Unterschleissheim, Germany). The endocardium of the free RV wall was manually traced starting from the lateral tricuspidal annulus to RV apex, and was tracked by the 2D strain software along the border throughout two cardiac cycles. Accuracy of border tracking was manually verified and adjusted if needed. The free right ventricular wall was segmented visually in a basal, midventricular and apical segment. For the determination of regional RV impairment we followed the approach of Dambrauskaite [17] and Lopez-Candalez [18]. Therefore only longitudinal lateral apical RV Sl (RVaSl) entered further analysis. Of note, RV speckle tracking analysis of free RV wall was applicable in all patients.


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)

Right ventricular speckle tracking and 3 dimensional visualisation of longitudinal right ventricular strain values.Right ventricular; 3D, three dimensional; RVSl, right ventricular longitudinal strain.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038519-g003: Right ventricular speckle tracking and 3 dimensional visualisation of longitudinal right ventricular strain values.Right ventricular; 3D, three dimensional; RVSl, right ventricular longitudinal strain.
Mentions: Figure 3 shows an example of RV ST analysis of RV deformation capabilities. Two cine loops from apical four chamber view were digitized and stored on an echocardiographic imaging server (XCELERA, Philips Medical Systems, Koninklijke N.V.). Offline 2D ST analyses of the gray scale images obtained by 2D echocardiography were done by using commercially available software (TomTec Imaging Systems GmbH, Unterschleissheim, Germany). The endocardium of the free RV wall was manually traced starting from the lateral tricuspidal annulus to RV apex, and was tracked by the 2D strain software along the border throughout two cardiac cycles. Accuracy of border tracking was manually verified and adjusted if needed. The free right ventricular wall was segmented visually in a basal, midventricular and apical segment. For the determination of regional RV impairment we followed the approach of Dambrauskaite [17] and Lopez-Candalez [18]. Therefore only longitudinal lateral apical RV Sl (RVaSl) entered further analysis. Of note, RV speckle tracking analysis of free RV wall was applicable in all patients.

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