Abstract

BACKGROUND: A mean pulmonary artery pressure >20 mmHg now defines pulmonary hypertension. We hypothesize that echocardiographic thresholds need to be adjusted.RESEARCH QUESTION: Should TRV thresholds to screen for PH be revised given the new hemodynamic definition?STUDY DESIGN AND METHODS: This multicenter retrospective study included 1,608 patients that underwent both echocardiography and right heart catherization within four weeks. The discovery cohort consisted of 1,081 individuals and the validation cohort included 527. Screening criteria for pulmonary hypertension were derived using receiver operating characteristic analysis and the Youden index assuming equal cost for false positive and negative classification. A lower threshold was calculated using a predefined sensitivity: 95%.RESULTS: In the discovery cohort, echocardiographic tricuspid regurgitation velocity had a good discrimination for pulmonary hypertension, AUC 88.4 (95% CI, 85.3-91.5). A 3.4 m/s threshold provided a 78% sensitivity, 87% specificity, and 6.13 positive likelihood ratio to detect pulmonary hypertension. 2.7 m/s had a 95% sensitivity and 0.12 negative likelihood ratio to exclude pulmonary hypertension. In the validation cohort, the discovery threshold of 2.7 m/s provided a sensitivity and negative likelihood ratio of 80% and 0.34, respectively. Right cardiac size improved detection of pulmonary hypertension in the lower tricuspid regurgitation velocity groups.INTERPRETATION: Our data support a lower tricuspid regurgitation velocity around 2.7 m/s for screening pulmonary hypertension with a high sensitivity in tertiary referral centers. Right heart chamber measurements improve the diagnostic yield of echocardiography.

View details for DOI 10.1016/j.chest.2021.06.046

View details for PubMedID 34217680