Relevance of echocardiographic composite index to improve the detection of pulmonary hypertension

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Introduction and Objective : The transthoracic echocardiography (TTE) is indicated for the detection of pulmonary hypertension (PH). The diagnosis is unlikely or probable according to a threshold value of tricuspid regurgitation peak velocity, the estimation of the systolic pulmonary arterial pressure (SPAP) with or without TTE indices of right ventricular (RV) dysfunction. However, few data exist on the threshold values of these RV indices. Our goal is to describe echocardiographic criteria for better detection of HP. Design : Ninety four patients were prospectively studied. Within one hour prior to right heart catheterization, patients underwent a 2D echocardio-Doppler and speckle tracking strain analysis. We measured: TAPSE, right ventricular end-diastolic area (RVEDA),left ventricular end diastolic area (LVEDA), longitudinal RV global strain. The ratio RVEDA/LVEDA was calculated. ROC curves analysis defined sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPP) for all variables. Results: Invasive mean PAP was 37 ± 12 mmHg and pulmonary artery occlusion pressure was 11 ± 3 mmHg. A cut-off value of TR peak velocity higher than 2,8 m/sec could predict PH with a Sp of 77% and a PPV of 96%A cut-off value of RV global strain lower than 12% could predict PH with a Sp of 91% and a PPV of 97% A TAPSE lower than 19 mm could predict PH with a Sp of 92% and a PPV of 98%, a RVEDA higher than 17 cm2 could predict PH with a Sp of 77% and a PPV of 95% Conclusion: Screening for pulmonary hypertesnion by ETT is relevant using a combination of several indices: TR peak velocity > 2.8 m / sec and RV global strain <12%, RVEDA > 17 cm 2 and TAPSE <19 mm.

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