title: Echocardiographic prediction of pre- versus postcapillary pulmonary hypertension.
abstract: BACKGROUND
  The differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) is of major therapeutic relevance and thus requires optimal clinical probability assessment with echocardiography.
  
  
  METHODS
  We prospectively analyzed 152 consecutive patients referred to a PH center over a 1-year period undergoing quasi-simultaneous (within 1 hour) echocardiography and right heart catheterization. Echocardiography was performed as usually recommended for the assessment of PH and left heart conditions. PH was defined as a mean pulmonary artery pressure ≥ 25 mm Hg. Postcapillary PH was diagnosed on the basis of a pulmonary capillary wedge pressure >15 mm Hg.
  
  
  RESULTS
  Ten of 152 patients (7%) had no PH, 81 of 152 (53%) had precapillary PH, and 61 of 152 (40%) had postcapillary PH. The following five echocardiographic variables were found to predict precapillary PH: right heart chamber larger than the left (P = .0018), left ventricular eccentricity index > 1.2 (P = .0039), dilated inferior vena cava without inspiratory collapse (P = .0076), E/e' ratio ≤ 10 (P = .00001), and the right ventricle forming the heart apex (P = .0144). Beta coefficients from multiple logistic regression were significant for dilated inferior vena cava without inspiratory collapse (P = .0464) and E/e' ratio ≤ 10 (P = .0002). The score based on β coefficients, ranging from 3 to 34 points, resulted in optimal discrimination at >5, with a positive predictive value of 67.9% and a negative predictive value of 77.5% for precapillary PH.
  
  
  CONCLUSIONS
  Echocardiography enables a clinically satisfactory differential diagnosis between pre- and postcapillary PH.
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy. Electronic address: mic.dalto@tin.it.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Argiento
authors.affiliation: Department of Cardiology, Molière Longchamp Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Adriana
authors.initials: A
authors.lastname: Pavelescu
authors.affiliation: Department of Emergency, Erasme Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Mélot
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Correra
authors.affiliation: Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana," Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Department of Physiology, Faculty of Medicine, Erasme Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
mesh_terms: D000465:Algorithms; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000145:classification* / Q000000981:diagnostic imaging*; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Echocardiography; Postcapillary; Precapillary; Pulmonary hypertension; Right heart catheterization