Pulmonary artery acceleration time: a valid alternative when tricuspid regurgitation is missing

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Abstract Background the latest guidelines from the European Society of Cardiology (ESC) on the diagnosis of pulmonary hypertension recommend the use of peak tricuspid regurgitation velocity (TRV) as an initial measure. However, in a significant proportion of patients this measurement is not feasible due to the absence of regurgitation or inadequate quality of the Doppler signal curve. Pulmonary artery acceleration time (PAAT), on the other hand, is a measurement that can be easily obtained in nearly all patients. Purpose the aim of our study is to analyse the relationship between PAAT and TRV and to evaluate its diagnostic accuracy for the TRV values established in the latest ESC guidelines (2.8m/s and 3.4m/s), determining appropriate cut-off points for this purpose. Methods a retrospective analysis was conducted on 1,255 consecutive transthoracic echocardiograms in which both TRV and PAAT were measured. Patients with pulmonary stenosis (peak velocity ≥ 2m/s) were excluded. The relationship between both variables was analyzed using different linear and non-linear models, choosing the one with the lowest degree of residuals. Diagnostic accuracy was assessed using the area under the curve (AUC) and sensitivity (Se) and specificity (Sp) values. Optimal cut-off points (OCP) were derived from ROC curve analysis. Results the mean age of the sample was 72.5±13.8 years, with 54% (683) being women and 63% (795) in sinus rhythm. Eighty six patients (7%) exhibited severe, massive or torrential tricuspid regurgitation. The mean TRV was 2.77±0.47m/s and the mean PAAT was 100.50±29.40ms. The mean TAPSE was 21.34±4.70mm, with 196 patients (16%) having systolic dysfunction (defined as TAPSE < 17mm). The relationship between TRV and PAAT fits a quadratic model (p for the quadratic term <0.001). The diagnostic accuracy of PAAT for both TRV cut-off points was good: TRV > 2.8m/s: AUC 0.78 [95% CI 0.76-0.80], OCP 93ms [Se 72.4%, Sp 71.8%]; TRV > 3.4m/s: AUC 0.80 [95% CI 0.78-0.82], OCP 85ms [Se 77.5%, Sp 70.6%]. Conclusions the relationship between TRV and PAAT follows a non-linear model. Cut-off points of 93ms and 85ms demonstrate good discriminatory power for identifying patients with TRV superior to 2.8m/s and 3.4m/s, respectively. Therefore, PAAT constitutes a reliable alternative for the initial echocardiographic assessment of the pulmonary hypertension probability in patients in whom TRV cannot be determined. Relationship PAAT/TRV

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