Abstract
Background: Pulmonary hypertension is observed in 70% of patients with left ventricular (LV) dysfunction. Right heart catheterization is the gold standard for a complete evaluation of Pulmonary Hypertension (PH); however, echocardiography represents a powerful initial diagnostic tool. The aim of our study was to evaluate the accuracy of echocardiography for the diagnosis of postcapillary PH, i.e., due to increased left ventricular filling pressures. Methods and Results: We recruited patients with a diagnosis of PH from the RIGHT1 study (Right heart invasive and echocardiographic hemodynamic evaluation in Turin 1). Transthoracic echocardiography was performed within 60 min of cardiac catheterization. High LV filling pressures were defined by a pulmonary arterial wedge pressure (PAWP) greater than 15 mmHg. We assessed numerous morphological and functional features of LV, and their association with PAWP. 128 patients were diagnosed with PH. We observed a significant association between PAWP, the left atrial volume indexed by BSA (LAVi, R2 = 0.27; p < 0.0001) and the E/e’ ratio (R2 = 0.27; p < 0.0001). With these parameters, we implemented a diagnostic algorithm to identify high ventricular filling pressures in PH patients. The application of this algorithm could help identify patients with a diagnosis of postcapillary PH due to high ventricular filling pressures (E/E’ > 15). Conclusions: The echocardiographic parameters with the best association with PAWP in PH patients are E/e’ and LAVi. For these patients, our diagnostic algorithm could improve the diagnostic precision for the definition of subgroups.
Highlights
Congestive heart failure (HF) affects 10% of people aged 75 and older, and it represents one of the main causes of hospitalization in subjects over 65 years old [1,2]
PH = Pulmonary Hypertension; LVMi = Left Ventricular Mass indexed by body surface area (BSA); RWT = relative wall thickness; LV ESV = left ventricular end systolic volume; LV EDV = left ventricular end diastolic volume; MV = mitral valve; AV = aortic valve; LAVi = left atrial volume indexed by BSA; FAC = fractional area change; RVD1 = basal right ventricular dimension; TR = tricuspid regurgitation
LVMi = Left Ventricular Mass indexed by BSA; LV ESV = left ventricular end systolic volume; LV EDV = left ventricular end diastolic volume; PV S/D ratio = Vein Pulmonary Doppler Ratio S/D; IVRT = isovolumetric relaxation time; LAVi = left atrial volume indexed by BSA
Summary
Congestive heart failure (HF) affects 10% of people aged 75 and older, and it represents one of the main causes of hospitalization in subjects over 65 years old [1,2]. Hearts 2020, 1 filling pressures, as defined by increased pulmonary arterial wedge pressure (PAWP) measured by right heart catheterization (PAWP > 15) [4,5] Another form of PH, i.e., precapillary PH, shows low values of wedge pressure (PAWP ≤ 15) and is not causally related to heart disease. Two different previous studies have proposed echocardiographic scores, in order to diagnose precapillary PH with echocardiography [10,11] Both scores have low overall specificity and positive predictive values, compromising their use as diagnostic tools. The aim of our study was to evaluate the accuracy of echocardiography for the diagnosis of postcapillary PH, i.e., resulting from increased left ventricular filling pressures
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