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Echocardiographic score for prediction of pulmonary hypertension at catheterization

the Daunia Heart Failure Registry

Correale, Michelea; Tricarico, Luciab; Padovano, Giuseppinab; Ferraretti, Armandoc; Monaco, Ileniab; Musci, Rita L.d; Galgano, Giusepped; Di Biase, Matteoe; Brunetti, Natale D.f

Journal of Cardiovascular Medicine: December 2019 - Volume 20 - Issue 12 - p 809–815
doi: 10.2459/JCM.0000000000000853
Research articles: Cardiovascular imaging
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Background Right heart catheterization (RHC) is recommended by guidelines for the diagnosis of pulmonary hypertension, the definition of hemodynamic impairment and responsiveness to drug therapy. However, RHC is an invasive test with associated risk of complications. Noninvasive echocardiographic tools, possibly predictive of pulmonary hypertension at RHC, could be therefore extremely useful.

Methods Sixty-four consecutive patients with suspected pulmonary hypertension were enrolled in the study and assessed by echocardiography and RHC. Diagnosis of pulmonary hypertension was based on mean pulmonary artery pressure (≥25 mmHg) at RHC.

Results Of 64 consecutive patients enrolled, 77% were diagnosed as having pulmonary hypertension after RHC. On the basis of significant differences between patients with pulmonary hypertension at RHC and those without on echocardiographic assessment, a multiple logistic regression model was constructed to predict the presence of pulmonary hypertension at RHC. The score was calculated using right atrium and ventricular diastolic area, tricuspid regurgitation Vmax, tricuspid regurgitation severity degree and left ventricular ejection fraction. The score area under the curve was therefore 0.786 (P = 0.0001), higher than for tricuspid regurgitation Vmax (P = 0.06). A score value more than 57 was associated with a 93% sensitivity, a 67% specificity, a 91% positive predictive power, a 73% negative predictive power, and an odds ratio 27 (P < 0.001) of pulmonary hypertension at RHC, significant even after correction at multivariable analysis. Accuracy of the prediction model was assessed in a validation cohort with comparable results (P = n.s.).

Conclusion A simple noninvasive echocardiographic score can be useful in predicting the diagnosis of pulmonary hypertension at RHC and may be considered for the selection of patients who should undergo or could avoid RHC.

aOspedali Riuniti University Hospital

bDepartment of Medical & Surgical Sciences, University of Foggia, Foggia

cCardiology Department, Ospedale ‘Caduti in Guerra’, Canosa

dCardiology Department, Ospedale Regionale Miulli

eGVM Care & Research, Santa Maria Hospital, Bari

fCardiology Department, University of Foggia, Foggia, Italy

Correspondence to Natale D. Brunetti, MD, PhD, FESC, Department of Medical & Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy Tel: +39 338 9112358; fax +39 0881 745424; e-mail: natale.brunetti@unifg.it

Received 20 June, 2018

Revised 7 April, 2019

Accepted 24 July, 2019

© 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.