Impact of Severe Tricuspid Regurgitation on Accuracy of Echocardiographic Pulmonary Artery Systolic Pressure Estimation.
BACKGROUND
Transthoracic Doppler echocardiography (DE) is recommended for screening and monitorization of pulmonary arterial hypertension (PAH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery systolic pressure (PASP) estimates may frequently be inaccurate. Some hemodynamic and echocardiographic factors are known to contribute to discordant results. The aim of this study was to determine whether severe tricuspid regurgitation (TR) has any impact on true estimation of PASP by DE.


METHODS
We retrospectively identified all PAH patients who underwent right heart catheterization (RHC) and had an echocardiogram within the same hospitalization period. Patients were divided into two groups according to the presence of severe TR: Group 1 consisted of 36 patients with mild-moderate TR and group 2 of 36 patients with severe TR. For these two groups, the agreement between echocardiographic and catheterization PASP measurements was evaluated by Bland-Altman analysis, separately.


RESULTS
In group 1, the bias for the echocardiographic estimates of the PASP was 2.5 mmHg and 62.5% of the echocardiographic estimates were accurate (≤10 mmHg difference with RHC measurement). In group 2, the bias was 16.25 mmHg and echocardiography was accurate in 37.5% of the patients. To clarify the association between PASP overestimation on DE and the presence of severe TR, regression analysis was performed. Severe TR was found as the only independent predictor of PASP overestimation on echocardiography after multivariate analysis.


CONCLUSIONS
The results of the study show that in patients with PAH, the presence of severe TR is associated with an overestimated PASP measurement on echocardiography.
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Ebru
E
Özpelit
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Bahri
B
Akdeniz
Department of Cardiology, School of Medicine, Izmir University, Medicalpark Hospital, Izmir, Turkey.
Emre Mehmet
EM
Özpelit
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Sedat
S
Tas
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Erkan
E
Alpaslan
Department of Biostatistics and Medical Informatics, School of Medicine, Akdeniz University, Antalya, Turkey.
Selen
S
Bozkurt
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Abdulla
A
Arslan
Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Özer
Ö
Badak
D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013599:Systole / Q000502:physiology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology
Doppler echocardiography; cardiac catheterization; cardiac hemodynamics; pulmonary artery pressure; pulmonary hypertension; tricuspid regurgitation