Abstract
AimsTo determine the value of echocardiography including tissue Doppler imaging (TDI) and right ventricular (RV) speckle tracking analysis for the diagnosis of pulmonary hypertension (PH) and discrimination between pre- and postcapillary PH.Methods and Results155 consecutive patients (mean age 70.5±13.0 years, 81 [52%] male gender, BMI 27.2±6.1 kg/m2) with PH undergoing right heart catheterization (RHC) and transthoracic echocardiography (TTE) with TDI between January 2008 and December 2009 were retrospectively evaluated including offline speckle tracking analysis of RV contractility. After RHC 23.2% of patients (36) were diagnosed with precapillary PH. Invasive results from RHC were significantly correlated to TTE measurements (E/é, postcapillary wedge pressure [PCWP], r = 0.61, P<0.001; mean, systolic pulmonary arterial pressure [mPAP, sPAP], r = 0.43, P<0.001). Single echocardiographic parameters were of good predictive value for final PH-diagnosis (sPAP, area under the curve [AUC] 0.63, P = 0.025; lateral apical RV longitudinal strain [RVaSl)], AUC 0.76, P = 0.001; E/é, AUC 0.84, P<0.001) which could be increased by combining most predictive parameters after receiver operating curves (ROC) cut off analysis (sPAP>69 mmHg, E/é<12, RVaSl ≥−8.4%). TTE had a sensitivity of 33.33% and a specificity of 100% to identify patients with precapillary PH, and a negative predictive value of 84.72% to rule out precapilary PH.ConclusionEchocardiography allows feasible and reliable estimation of PH and seems helpful to distinguish between pre-and postcapillary PH. Further prospective studies on patients with different manifestations of PH must validate the predictive value of echocardiography in this clinical setting.
Highlights
Precapillary pulmonary arterial hypertension (PAH) is a severe and life threatening disease, leading to death if untreated within 2– 3 years after diagnosis [1]
Echocardiography allows feasible and reliable estimation of pulmonary hypertension (PH) and seems helpful to distinguish between preand postcapillary PH
Further prospective studies on patients with different manifestations of PH must validate the predictive value of echocardiography in this clinical setting
Summary
Precapillary pulmonary arterial hypertension (PAH) is a severe and life threatening disease, leading to death if untreated within 2– 3 years after diagnosis [1]. Definite diagnosis of PAH is often delayed with a median of 3 years from onset of first symptoms to start of effective therapy [2]. Current guidelines emphasize the importance of early diagnosis of precapillary PAH and differentiation from other entities of pulmonary hypertension (PH) [3]. Up to now definite diagnosis of PAH can only be confirmed by invasive right heart catheterization (RHC) which is not widely available, puts the patients at risk for rare but serious complications, and which is inconvenient for frequent follow up evaluations [4]. PAH is a rare disease and invasive RHC confirms postcapillary PH in most cases with elevated pulmonary pressure. It would be of great interest to identify a simple, non-invasive diagnostic algorithm which allows for (a) adequate PH diagnosis with a sufficient high reliability, and (b) discriminates between pre-and postcapillary PH
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