For a better estimation of pulmonary pressures by echocardiography: Need for quality improvement

Abstract

Echocardiography provides controversial accuracy in estimations of systolic pulmonary pressures (sPAP). The objective of this study was to determine the factor influencing the accuracy using echocardiography in patients with history of heart failure with preserved ejection fraction or pulmonary arterial hypertension. Between January 2014 and January 2018, 184 patients with suspected pulmonary hypertension, underwent right heart catheterization (RHC) and transthoracic echocardiography within 5 days in our referral centre. Right ventricular systolic pressure was estimated according to tricuspid regurgitation (TR) signal and compared to hemodynamic sPAP. Twelve parameters were studied to determine the reasons of lack of accuracy in the echocardiographic sPAP result, namely: the cause of the pulmonary hypertension, the heart rate, the presence of atrial fibrillation, the right atrial size, the operator's experience (young or experienced), the severity of the TR, the TR signal quality, the number of incidences recorded of TR images, the inferior vena cava size, the difference between echo and hemodynamic right atrial pressure measurement, the cardiac index and the mean PAP. A difference of 10 mmHg between echo and hemodynamic sPAP measurement was considered as significant. Seventy-nine patients (50%) had a very good TR signal quality. Twenty-seven patients (15%) had no signal or very poor TR signal quality. Seventy-eight patients (50%) had a difference > 10 mmHg between echo and Hemodynamic sPAP estimation. The parameters associated with a difference of 10 mmHg or more between both measurements were a higher mean PAP (43 ± 10 vs. 39 ± 8 mmHg; P = 0.001), the experience of the operator ( P = 0.008), and the number of acquisition of the TR signal ≥ 3 ( P = 0.017). Echocardiography reliably estimates sPAP when attention is given to quality metrics, the experience of the reader, and the mean PAP.