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Accuracy and Diagnostic Performance of Doppler Echocardiography to Estimate Mean Pulmonary Artery Pressure in Heart Failure
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  • Alva Bjorkman,
  • Lars H. Lund,
  • Ulrika Faxen,
  • Per Lindqvist,
  • Ashwin Venkateshvaran
Alva Bjorkman
Karolinska Institute
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Lars H. Lund
Karolinska Univ Hosp
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Ulrika Faxen
Karolinska Institute
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Per Lindqvist
Umeå University Hospital
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Ashwin Venkateshvaran
Karolinska Institute
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Abstract

BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAPM) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAPM in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRVmax). METHODS. PAPM was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAPM were assessed. Diagnostic performance of DE methods vs. TRVmax=2.8m/sec to identify invasive PAPM ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAPM, with relatively lower mean bias and higher precision observed in algorithms that included TRVmax or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRVmax (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAPM demonstrate reasonable accuracy to represent invasive PAPM and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRVmax. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.

Peer review status:UNDER REVIEW

08 Jun 2021Submitted to Echocardiography
09 Jun 2021Assigned to Editor
09 Jun 2021Submission Checks Completed
11 Jun 2021Reviewer(s) Assigned