title: Investigating the value of right heart echocardiographic metrics for detection of pulmonary hypertension in patients with advanced lung disease.
abstract: This study determined whether novel right heart echocardiography metrics help to detect pulmonary hypertension (PH) in patients with advanced lung disease (ALD). We reviewed echocardiography and catheterization data of 192 patients from the Stanford ALD registry and echocardiograms of 50 healthy controls. Accuracy of echocardiographic right heart metrics to detect PH was assessed using logistic regression and area under the ROC curves (AUC) analysis. Patients were divided into a derivation (n = 92) and validation cohort (n = 100). Experimental validation was assessed in a piglet model of mild PH followed longitudinally. Tricuspid regurgitation (TR) was not interpretable in 52% of patients. In the derivation cohort, right atrial maximal volume index (RAVI), ventricular end-systolic area index (RVESAI), free-wall longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) differentiated patients with and without PH; 20% of patients without PH had moderate to severe RV enlargement by RVESAI. On multivariate analysis, RAVI and TAPSE were independently associated with PH (AUC = 0.77, p < 0.001), which was confirmed in the validation cohort (0.78, p < 0.001). Presence of right heart metrics abnormalities did not improve detection of PH in patients with interpretable TR (p > 0.05) and provided moderate detection value in patients without TR. Only two patients with more severe PH (mean pulmonary pressure 35 and 36 mmHg) were missed. The animal model confirmed that right heart enlargement discriminated best pigs with PH from shams. This study highlights the frequency of right heart enlargement and dysfunction in ALD irrespectively from presence of PH, therefore limiting their use for detection of PH.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA. mamsalle@stanford.edu.|Stanford Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, 94305, USA. mamsalle@stanford.edu.
authors.forename: Myriam
authors.initials: M
authors.lastname: Amsallem
authors.affiliation: Laboratoire de Recherche Chirurgicale, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France.
authors.forename: David
authors.initials: D
authors.lastname: Boulate
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Kooreman
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.|Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Roham T
authors.initials: RT
authors.lastname: Zamanian
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fadel
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Ingela
authors.initials: I
authors.lastname: Schnittger
authors.affiliation: Laboratoire de Recherche Chirurgicale, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Fadel
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Michael V
authors.initials: MV
authors.lastname: McConnell
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Gundeep
authors.initials: G
authors.lastname: Dhillon
authors.affiliation: Laboratoire de Recherche Chirurgicale, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France.
authors.forename: Olaf
authors.initials: O
authors.lastname: Mercier
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: François
authors.initials: F
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000831:Animals, Newborn; D019540:Area Under Curve; D062186:Arterial Pressure; D002140:California; D002407:Catheterization, Swan-Ganz; D016009:Chi-Square Distribution; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D004195:Disease Models, Animal; D004452:Echocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D034421:Sus scrofa; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: Echocardiography; Lung disease; Pulmonary hypertension; Right heart failure; Strain