Diagnostic value of echocardiography in the diagnosis of pulmonary hypertension.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Department of Internal Medicine II, Cardiology/Pneumology, University of Bonn, Bonn, Germany.
Christoph
C
Hammerstingl
Robert
R
Schueler
Lisa
L
Bors
Diana
D
Momcilovic
Stefan
S
Pabst
Georg
G
Nickenig
Dirk
D
Skowasch
D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies