What influences echocardiography reliability in estimation of pulmonary pressure?

Abstract

If echocardiography provides reliable estimations of pulmonary pressures remain controversial. The objective of this study was to determine the accuracy of estimating right ventricular systolic pressure (RVSP) and the factor influencing this accuracy using echocardiography in patients with history of heart failure with preserved ejection fraction (HFpEF) or pulmonary arterial hypertension. Between January 2014 and December 2015, 118 patients with suspected pulmonary hypertension (PH), underwent right heart catheterization (RHC) and transthoracic echocardiography within 5 days in our referral center. The correlation in estimating RVSP according to tricuspid regurgitation (TR) signal quality and reader expertise were retrospectively determined. TR signal quality using continuous-wave Doppler were classified subjectively in three groups: good (type 1), moderate (type 2) and poor (type 3). We compared measurements from the echocardiography laboratory clinical report assessed by level 3–trained cardiologists certified in echocardiography, with offline reassessment by a level 1–young cardiologist blinded to RHC values. In total, 86 patients (72%) had a good or moderate TR signal quality. The comparison between clinical reports and young cardiologist reassessment gave a linear regression line having the equation y = −0, 1549 + 1, 0286 x. Correlation coefficient between RVSP estimation from RHC and echocardiography were respectively 0,69 (P < 0,001) from the clinical report and 0,62 (P < 0,001) from level 1 reader. When TR signal quality was good and moderate, correlation coefficient was respectively 0,75 (P < 0,001) from the clinical report and 0,72 (P < 0,001) from the level 1 reader. In 50 patients with type 1 TR quality signal, the correlation coefficient were respectively 0,83 (P < 0,001) and 0,78 (P < 001). Echocardiography reliably estimates RVSP when attention is given to quality metrics and the level of the reader.