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A simple echocardiographic score for the diagnosis of pulmonary vascular disease in heart failure

D’Alto, Michelea; Romeo, Emanuelea; Argiento, Paolaa; Pavelescu, Adrianab; D’Andrea, Antonelloa; Di Marco, Giovanni M.a; Mattera Iacono, Agostinoa; Sarubbi, Berardoa; Rea, Gaetanoc; Bossone, Eduardod; Russo, Maria G.a; Naeije, Roberte

Journal of Cardiovascular Medicine: April 2017 - Volume 18 - Issue 4 - p 237–243
doi: 10.2459/JCM.0000000000000485
Research articles

Aims A simple echocardiographic score was designed for diagnosing precapillary vs postcapillary pulmonary hypertension and for discriminating between isolated postcapillary pulmonary hypertension (Ipc-PH) and combined precapillary and postcapillary pulmonary hypertension (Cpc-PH).

Methods The score comprised 7 points (2 for E/e′ ratio ≤10, 2 for a dilated non-collapsible inferior vena cava, 1 for a left ventricular eccentricity index ≥1.2, 1 for a right-to-left heart chamber dimension ratio >1 and 1 for the right ventricle forming the heart apex) and was applied to 230 consecutive patients referred for evaluation of pulmonary hypertension.

Results Precapillary pulmonary hypertension and postcapillary pulmonary hypertension were diagnosed in 160 and 70 patients, respectively. In the latter, Ipc-PH was found in 51 and Cpc-PH in 19. The echo score was higher in precapillary vs postcapillary pulmonary hypertension patients (4.2 ± 1.7 vs 1.6 ± 1.7, P < 0.001) and in patients with Cpc-PH vs Ipc-PH (2.7 ± 2.1 vs 1.2 ± 1.3, P = 0.001). The sensitivity and specificity of the echo score at least 2 for precapillary pulmonary hypertension were 99 and 54%, respectively (area under the curve 0.85). In patients with postcapillary pulmonary hypertension, the sensitivity and specificity of the echo score at least 2 for Cpc-PH were 63 and 82% (area under the curve 0.73).

Conclusion A simple echocardiographic score helps in the differential diagnosis between precapillary and postcapillary pulmonary hypertension, and between Ipc-PH and Cpc-PH.

aDepartment of Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy

bDepartment of Cardiology, Moliére-Longchamp Hospital, Université Libre de Bruxelles, Belgium

cDepartment of Radiology, Monaldi Hospital, Naples

dDepartment of Cardiology and Cardiac Surgery, ‘San Giovanni di Dio e Ruggi d’Aragona’ University Hospital, Salerno, Italy

eDepartment of Cardiology, Erasme University Hospital, Brussels, Belgium

Correspondence to Michele D’Alto, MD, PhD, FESC, Department of Cardiology, Second University of Naples, Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy Tel: +39 081 7062501; fax: +39 081 7064275; e-mail:

Received 26 July, 2016

Revised 23 August, 2016

Accepted 2 October, 2016

© 2017 Italian Federation of Cardiology. All rights reserved.