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Accuracy of echocardiographic estimates of pulmonary artery pressures in pulmonary hypertension : insights from the KARUM hemodynamic database

Venkateshvaran, Ashwin ; Seidova, Natavan ; Tureli, Hande Oktay ; Kjellström, Barbro LU ; Lund, Lars H. ; Tossavainen, Erik and Lindquist, Per (2021) In International Journal of Cardiovascular Imaging 37(9). p.2637-2645
Abstract

Accurate assessment of pulmonary artery (PA) pressures is integral to diagnosis, follow-up and therapy selection in pulmonary hypertension (PH). Despite wide utilization, the accuracy of echocardiography to estimate PA pressures has been debated. We aimed to evaluate echocardiographic accuracy to estimate right heart catheterization (RHC) based PA pressures in a large, dual-centre hemodynamic database. Consecutive PH referrals that underwent comprehensive echocardiography within 3 h of clinically indicated right heart catheterization were enrolled. Subjects with absent or severe, free-flowing tricuspid regurgitation (TR) were excluded. Accuracy was defined as mean bias between echocardiographic and invasive measurements on Bland–Altman... (More)

Accurate assessment of pulmonary artery (PA) pressures is integral to diagnosis, follow-up and therapy selection in pulmonary hypertension (PH). Despite wide utilization, the accuracy of echocardiography to estimate PA pressures has been debated. We aimed to evaluate echocardiographic accuracy to estimate right heart catheterization (RHC) based PA pressures in a large, dual-centre hemodynamic database. Consecutive PH referrals that underwent comprehensive echocardiography within 3 h of clinically indicated right heart catheterization were enrolled. Subjects with absent or severe, free-flowing tricuspid regurgitation (TR) were excluded. Accuracy was defined as mean bias between echocardiographic and invasive measurements on Bland–Altman analysis for the cohort and estimate difference within ± 10 mmHg of invasive measurements for individual diagnosis. In 419 subjects, echocardiographic PA systolic and mean pressures demonstrated minimal bias with invasive measurements (+ 2.4 and + 1.9 mmHg respectively) but displayed wide limits of agreement (− 20 to + 25 and − 14 to + 18 mmHg respectively) and frequently misclassified subjects. Recommendation-based right atrial pressure (RAP) demonstrated poor precision and was falsely elevated in 32% of individual cases. Applying a fixed, median RAP to echocardiographic estimates resulted in relatively lower bias between modalities when assessing PA systolic (+ 1.4 mmHg; 95% limits of agreement + 25 to − 22 mmHg) and PA mean pressures (+ 1.4 mmHg; 95% limits of agreement + 19 to − 16 mmHg). Echocardiography accurately represents invasive PA pressures for population studies but may be misleading for individual diagnosis owing to modest precision and frequent misclassification. Recommendation-based estimates of RAPmean may not necessarily contribute to greater accuracy of PA pressure estimates.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Doppler echocardiography, Right heart catheterization, Tricuspid regurgitation peak velocity
in
International Journal of Cardiovascular Imaging
volume
37
issue
9
pages
2637 - 2645
publisher
Springer
external identifiers
  • scopus:85108274852
  • pmid:34146206
ISSN
1569-5794
DOI
10.1007/s10554-021-02315-y
language
English
LU publication?
yes
id
6a8f0ea0-26d3-4194-9217-49d8135362fe
date added to LUP
2021-07-12 14:24:58
date last changed
2024-02-20 09:16:04
@article{6a8f0ea0-26d3-4194-9217-49d8135362fe,
  abstract     = {{<p>Accurate assessment of pulmonary artery (PA) pressures is integral to diagnosis, follow-up and therapy selection in pulmonary hypertension (PH). Despite wide utilization, the accuracy of echocardiography to estimate PA pressures has been debated. We aimed to evaluate echocardiographic accuracy to estimate right heart catheterization (RHC) based PA pressures in a large, dual-centre hemodynamic database. Consecutive PH referrals that underwent comprehensive echocardiography within 3 h of clinically indicated right heart catheterization were enrolled. Subjects with absent or severe, free-flowing tricuspid regurgitation (TR) were excluded. Accuracy was defined as mean bias between echocardiographic and invasive measurements on Bland–Altman analysis for the cohort and estimate difference within ± 10 mmHg of invasive measurements for individual diagnosis. In 419 subjects, echocardiographic PA systolic and mean pressures demonstrated minimal bias with invasive measurements (+ 2.4 and + 1.9 mmHg respectively) but displayed wide limits of agreement (− 20 to + 25 and − 14 to + 18 mmHg respectively) and frequently misclassified subjects. Recommendation-based right atrial pressure (RAP) demonstrated poor precision and was falsely elevated in 32% of individual cases. Applying a fixed, median RAP to echocardiographic estimates resulted in relatively lower bias between modalities when assessing PA systolic (+ 1.4 mmHg; 95% limits of agreement + 25 to − 22 mmHg) and PA mean pressures (+ 1.4 mmHg; 95% limits of agreement + 19 to − 16 mmHg). Echocardiography accurately represents invasive PA pressures for population studies but may be misleading for individual diagnosis owing to modest precision and frequent misclassification. Recommendation-based estimates of RAP<sub>mean</sub> may not necessarily contribute to greater accuracy of PA pressure estimates.</p>}},
  author       = {{Venkateshvaran, Ashwin and Seidova, Natavan and Tureli, Hande Oktay and Kjellström, Barbro and Lund, Lars H. and Tossavainen, Erik and Lindquist, Per}},
  issn         = {{1569-5794}},
  keywords     = {{Doppler echocardiography; Right heart catheterization; Tricuspid regurgitation peak velocity}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{2637--2645}},
  publisher    = {{Springer}},
  series       = {{International Journal of Cardiovascular Imaging}},
  title        = {{Accuracy of echocardiographic estimates of pulmonary artery pressures in pulmonary hypertension : insights from the KARUM hemodynamic database}},
  url          = {{http://dx.doi.org/10.1007/s10554-021-02315-y}},
  doi          = {{10.1007/s10554-021-02315-y}},
  volume       = {{37}},
  year         = {{2021}},
}