Pressure reflection in the pulmonary circulation by echocardiography in patients with left heart disease indicates reactive pulmonary hypertension.
OBJECTIVE
The two hemodynamic profiles in left heart disease (LHD) with pulmonary hypertension (PH), passive PH with increased pulmonary venous pressure and reactive PH with increased pulmonary vascular resistance (PVR > 3 Wood units, WU), are difficult to distinguish non-invasively. We hypothesized that echocardiographic signs of pressure reflection (PR) in the pulmonary circulation can be used to diagnose reactive PH.


METHODS
The study comprised 122 patients divided into three groups: patients without PH (No PH, n = 61), patients with LHD, PH and normal PVR (passive PH, n = 29) and patients with LHD, PH and increased PVR (reactive PH, n = 32). Echocardiography and right heart catheterization were performed within 24 h. Three parameters were selected related to PR [the acceleration of flow in the right ventricular outflow tract (RVOT), the interval and the augmentation of pressure between peak RVOT flow and peak RV pressure]. Cutoff values aiming at ruling in (high positive likelihood ratio, PLR) and ruling out (low negative likelihood ratio, NLR) increased PVR were determined using receiver operator characteristic (ROC) curves.


RESULTS
The proportions of the patients with PH and PVR > 3 WU were 50% and 29%. Twenty-one percent had both increased pulmonary capillary wedge pressure and PVR. The area under the ROC curve for the PR parameters was 0.82-0.89. The PLR with ruling in cutoff values ranged from 4.7 to 9.4. The NLR with ruling out cutoff values ranged from 0.20 to 0.12.


CONCLUSIONS
Echocardiographic assessment of PR in patients with LHD can be used to identify or exclude reactive PH.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Electronic address: odd.bech-hanssen@klinfys.gu.se.
Odd
O
Bech-Hanssen
Bahaa
B
Fadel
Waleed
W
Al Habeeb
Jehad
J
Al Buraiki
Nedim
N
Selimovic
D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology*; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies
AP; Echocardiography; LHD; Left heart disease; PAMP; PASP; PCWP; PH; PR; PVR; Pressure reflection; Pulmonary hypertension; Pulmonary vascular resistance; RHC; RVOT; Reactive pulmonary hypertension; WU; Wood units; augmented pressure; left heart disease; pressure reflection; pulmonary artery mean pressure; pulmonary artery systolic pressure; pulmonary capillary wedge pressure; pulmonary hypertension; pulmonary vascular resistance; right heart catheterization; right ventricular outflow tract