title: Non-invasive diagnosis of pulmonary hypertension from lung Doppler signal: a proof of concept study.
abstract: Transthoracic Parametric Doppler (TPD) is a novel ultrasound technique recently developed for the investigation of pulmonary blood vessels. Lung Doppler Signals (LDS) recorded from TPD provide information regarding the functional mechanical characteristics of pulmonary blood vessels. We aimed to define the specific profile of LDS generated from TPD imaging in patients with pulmonary hypertension (PH), and to evaluate the diagnostic performance of LDS to detect PH using right heart catheterization (RHC) as gold standard reference. Seventy nine PH patients and 79 healthy controls matched for age, gender and BMI were recruited in a prospective case-control multicenter study. LDS recordings were performed by TPD consisting of a pulsed Doppler with a 2 MHz single element transducer. LDS were recorded within 24 h of RHC. Following LDS extraction, classification and performance evaluation were performed offline using a support vector machine (k-fold cross validation method). The best LDS parameters for PH detection were (1) peak velocity of the systolic (S) and diastolic (D) signals, (2) the rise slope of the S and D signals, and (3) time to peak of the S signal. Overall, the sensitivity and specificity of TPD for detection of PH were 82.7 % (95 % CI 81.3-84.1) and 87.4 % (95 % CI 86.3-88.5), respectively, with an area under the receiver operating curve of 0.95 (95 % CI 0.94-0.96). Detection rate of PH increased progressively with the level of mean pulmonary artery pressure. LDS recorded by TPD display a specific profile in PH and appears to be a promising and reliable tool for PH diagnosis. Further studies are required to confirm the clinical usefulness of LDS.
authors.affiliation: Faculté de Médecine, Univ. Paris-Sud, 94270, Le Kremlin Bicêtre, France. Laurent.Godinas@uclouvain.be.|AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, 94270, Le Kremlin Bicêtre, France. Laurent.Godinas@uclouvain.be.|UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France. Laurent.Godinas@uclouvain.be.|Service de Pneumologie, CHU Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium. Laurent.Godinas@uclouvain.be.
authors.forename: Laurent
authors.initials: L
authors.lastname: Godinas
authors.affiliation: AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, 94270, Le Kremlin Bicêtre, France.|Service de Pneumologie, Programme Hypertension Pulmonaire, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lador
authors.affiliation: EchoSense Ltd., Haifa, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Schatzberger
authors.affiliation: Faculté de Médecine, Univ. Paris-Sud, 94270, Le Kremlin Bicêtre, France.|AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, 94270, Le Kremlin Bicêtre, France.|UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France.
authors.forename: Sven
authors.initials: S
authors.lastname: Günther
authors.affiliation: Sheba Medical Center, Tel Hashomer, Israel.|Sackler Medical School, Tel-Aviv, Israel.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Segel
authors.affiliation: EchoSense Ltd., Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Palti
authors.affiliation: EchoSense Ltd., Haifa, Israel.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Maisuls
authors.affiliation: Faculté de Médecine, Univ. Paris-Sud, 94270, Le Kremlin Bicêtre, France.|AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, 94270, Le Kremlin Bicêtre, France.|UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sitbon
authors.affiliation: Faculté de Médecine, Univ. Paris-Sud, 94270, Le Kremlin Bicêtre, France.|AP-HP, Centre de Référence de l'Hypertension Pulmonaire Sévère, Département Hospitalo-Universitaire (DHU) Thorax Innovation (TORINO), Service de Pneumologie, Hôpital de Bicêtre, 94270, Le Kremlin Bicêtre, France.|UMR_S 999, Univ. Paris-Sud, INSERM, Laboratoire d'Excellence (LabEx) en Recherche sur le Médicament et l'Innovation Thérapeutique (LERMIT), Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France.
authors.forename: Gérald
authors.initials: G
authors.lastname: Simonneau
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001808:Blood Vessels; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D016000:Cluster Analysis; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D015150:Echocardiography, Doppler / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D000075082:Proof of Concept Study; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D012107:Research Design; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
keywords: Detection; Lung doppler signal; Non-invasive diagnosis; Pulmonary hypertension; Screening