Tricuspid regurgitation velocity versus right ventricular systolic pressure in the echocardiographic evaluation of pulmonary hypertension

Abstract

Background In consecutive patients who underwent right heart catheterization for pulmonary hypertension (PH) diagnosis, we evaluate ECS/ERS 2015 PH guidelines regarding the echocardiographic suggestions to proceed to PH diagnosis. Methods We enrolled patients referred to Right heart catheterization (RHC) for hemodynamic assessment of presumed PH at respiratory institute Cleveland Clinic. We compared the RHC pulmonary hemodynamic determinations with transthoracic echocardiographic right ventricle systolic pressure (RVSP) and peak tricuspid regurgitation velocity (TRV). Results We included 136 patients in the analysis, where 88 (64.7%) were females and 98 (72%) were of white race. New York Heart Association functional class was II or III in 113 (81%) patients. Peak TRV was significantly associated with BMI (R, 0.192; P=0.048), pulmonary artery systolic (R, 0.37; P<0.001), diastolic (R, 0.23; P=0.02), and mean pressures (R, 0.315; P=0.001). RVSP estimated by echocardiography was associated with the one measured during right heart catheterization (R, 0.52; P<0.001). Transthoracic echocardiographic TRV sensitivity was 79.8%, specificity 66.6%, positive predictive value 89.7%, and negative predictive value 47.4% to determine PH using composite analysis. Moreover, transthoracic echocardiographic RVSP had a sensitivity of 92%, specificity of 34.6%, positive predictive value of 84.4%, and negative predictive value of 52.947% to determine PH using the Bernoulli equation. Conclusions The use of the last guideline TRV composite analysis improves echocardiographic specificity and positive predictive value, but lacks sensitivity.

Keywords

• pulmonary hypertension
• right ventricle systolic pressure
• tricuspid regurgitation velocity