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A Simple Echocardiographic Prediction Rule for Hemodynamics in Pulmonary Hypertension
Study Questions:
Can standard echocardiographic measurements differentiate pulmonary hypertension (PH) caused by pulmonary vascular disease (PVD) versus other causes such as pulmonary venous hypertension?
Methods:
The study examined echocardiography findings, invasive hemodynamics, and clinical variables in 108 individuals referred to a PH clinic with both echocardiography and right heart catheterization performed within 1 year. Patients were excluded if they had interval changes in management, interval major surgery, incomplete echocardiography, or were on intravenous inotropes/vasopressors or positive pressure ventilation during the study. Patients were stratified into those with or without PVD, with PVD defined as a pulmonary artery wedge pressure ≤15 mm Hg and a pulmonary vascular resistance >3 Wood units. The study examined echocardiographic predictors of PVD, and derived a prediction model that was prespecified to utilize up to four standard echocardiographic variables.
Results:
Based on invasive hemodynamics, 52 of the 108 individuals were classified as having PVD. The derived score was based on four criteria: 1) left atrial diameter <3.2 cm (+1), 2) presence of mid-systolic notch or acceleration time <80 msec (+1); 3) a lateral mitral E:e’ >10 (-1); and 4) left atria diameter >4.2 cm (-1). The total score ranged from -2 to +2, with a higher score suggesting an increased likelihood of PVD. A score ≥0 was associated with a sensitivity of 100% and a specificity of 62% to identify PH with PVD. The area under the curve performance of the score was 0.90, and did not significantly increase using more complex scoring systems or by substituting additional variables.
Conclusions:
The authors concluded that a simple echocardiography score may be useful to determine the likelihood of PVD in patients with suspected PH.
Perspective:
This study developed a highly useful prediction model that may be able to determine which patients with suspected PH are likely to have PVD, which may help identify individuals who may benefit from further evaluation by right heart catheterization. A strength of this study is that it intentionally created a simple algorithm that can be easily remembered and applied using standard echocardiographic measurements. Future studies are needed to validate this score in additional populations.
Keywords: Heart Atria, Pulmonary Wedge Pressure, Sensitivity and Specificity, Cardiac Catheterization, Vascular Diseases, Systole, Hemodynamics, Heart Diseases, Veins, Positive-Pressure Respiration, Heart Failure, Hypertension, Pulmonary, Hydrogen-Ion Concentration, Vascular Resistance, Echocardiography
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