Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension.
This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC = 0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.
Duke Medicine Residency Program, Department of Medicine, Duke University Hospital, Durham, NC, USA.
Kathleen
K
Broderick-Forsgren
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
Clemontina A
CA
Davenport
Division of Cardiology, Department of Medicine, Duke University Medical Center, Rm 3347A, Orange Zone, Duke South, Durham, NC, 27710, USA.
Joseph A
JA
Sivak
Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA.
Charles William
CW
Hargett
Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Michael C
MC
Foster
Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Andrew
A
Monteagudo
Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Alicia
A
Armour
Division of Cardiology, Department of Medicine, Duke University Medical Center, Rm 3347A, Orange Zone, Duke South, Durham, NC, 27710, USA.
Sudarshan
S
Rajagopal
Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Kristine
K
Arges
Division of Cardiology, Department of Medicine, Duke University Medical Center, Rm 3347A, Orange Zone, Duke South, Durham, NC, 27710, USA.|Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA.
Eric J
EJ
Velazquez
Division of Cardiology, Department of Medicine, Duke University Medical Center, Rm 3347A, Orange Zone, Duke South, Durham, NC, 27710, USA. zainab.samad@duke.edu.|Cardiac Diagnostic Unit, Duke University Medical Center, Durham, NC, USA. zainab.samad@duke.edu.
Zainab
Z
Samad
D019540:Area Under Curve; D006328:Cardiac Catheterization; D004452:Echocardiography; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right; D017725:Ventricular Pressure
Diagnostic characteristics; Echocardiogram; Pulmonary hypertension; Right ventricular systolic pressure (RVSP)