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Accuracy and precision of systolic pulmonary pressure assessed by echocardiography among patients with pulmonary hypertension

Session Poster Session 3

Speaker Adrian Lescano

Congress : Heart Failure 2016

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Hypertension
  • Session type : Poster Session
  • FP Number : P1742

Authors : A Lescano (Buenos Aires,AR), A Lavalle Cobo (Buenos Aires,AR), H Santa Maria (Buenos Aires,AR), G Damianich (Buenos Aires,AR), A Ferro (Buenos Aires,AR), N Gonzalez (Buenos Aires,AR), C Musante (Quilmes,AR), G Dionisio (CABA,AR), M Gonzalez (CABA,AR), H Grancelli (CABA,AR)

Authors:
A Lescano1 , A Lavalle Cobo1 , H Santa Maria1 , G Damianich1 , A Ferro1 , N Gonzalez1 , C Musante2 , G Dionisio3 , M Gonzalez3 , H Grancelli3 , 1Finochietto Clinic - Buenos Aires - Argentina , 2Sanatorio de la Trinidad - Quilmes - Argentina , 3Hospital Santojanni - CABA - Argentina ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2016 ) 18 ( Supplement 1 ), 416

Background: Non-invasive estimation of pulmonary pressures by Doppler echocardiography (DE) is an important tool for the management of pulmonary hypertension (PH) patients. Previous reports suggested the use of the velocity-time integral of the tricuspid reflux (VTI-TR) for estimating the mean pulmonary pressure (MPP). However, there is limited information regarding precision and accuracy of the VTI-TR. Objective: Estimate the correlation between mean pulmonary pressures assessed by DE using the tricuspid VTI and right heart catheterization (RHC). Material and methods: Patients with confirmed PH diagnosis (MPP ≥ 25 mm Hg) that underwent RHC between March 2012 and May 2015 from three heart failure centers were included in the analysis. The echocardiographic studies were performed using two ultrasound systems (Vivid 5s and Esaote 30 Gold). The MPP was obtained by adding the VTI-TR to the estimated right atrial pressure (RAP), determined by the variation in the size of the inferior vena cava with inspiration. Hemodynamic confirmation of pulmonary pressures was obtained by a RHC using a Swan-Ganz catheter. RHC and DE were performed with less than 24 hours of difference between them and the physicians were blind to echocardiography results. The MPP obtained by the two methods were compared using Lin´s concordance correlation coefficient and Bland Altman plot. MPP was categorized in 11 groups per 10 mmHg increase and quadratic weighted kappa (k) was performed for qualitative agreement measures. Results: A total of 80 patients with diagnosis of PH were included. Mean age was 57.5 years (SD 19) and 73% were women. PH group (G) distribution was GI 64%; GII 16%; GIII 8%; GIV 6% and GV 6%. 79% had heart failure, 26% syncope and 23% chest pain; mean distance in the 6 minute walk test was 326 meters (SD 137). Mean RHC pressures (mm Hg) were: MPP 48 (SD 15), systolic pulmonary pressure (SPP) 76 (SD20), diastolic pulmonary pressure (DPP) 34 (SD12), RAP 10 (SD 5,1). The transpulmonary gradient was 35 and mean cardiac index 2,7 liters/min/mts2. Analysis of DE data shown: mean TAPSE 18 mm (SD 4), SPP 73 mm Hg (SD 16) and MPP 45,6 mm Hg (SD 12,1). The concordance correlation coefficient resulted in 0.83 (95% CI 0.74-0.88), with a Pearson r of 0.84 (precision) and a Cb correction factor of 0.97 (accuracy) (figure 1). The Bland Altman plot shows a mean difference of 2 mmHg (SD 7,6). The k coefficient was 0.80 (95% CI 0.70-0.90). Although related to a small number of observations, DE underestimated MPP above 70 mmHg. Conclusion: A moderate to high correlation in MPP assessment between a noninvasive technique (VTI-TR) and right heart catheterization was observed among patients with PH. These results supports the use of DE as a reliable diagnosis measure of MPP among patients with PH. Further research may be needed to assess accuracy in very high PH patients (MPP above 70 mmHg).

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