INTRODUCTION
Pulmonary hypertension (PH) is common in heart failure
(HF)1 and is associated with poor
prognosis.2 Passive downstream elevations in left
heart pressures often combined with pulmonary arteriolar remodeling are
seen both in HF with preserved (HFpEF) and reduced ejection fraction
(HFrEF) and carry therapeutic implications.3 PH is
defined as per current recommendations as a mean pulmonary artery
pressure (PAPM) ≥ 25mmHg at rest, measured during right
heart catheterization (RHC).4 Although definite PH
diagnosis necessitates an invasive evaluation of PAPM,Doppler echocardiography (DE) is routinely employed to screen for PH and
evaluate hemodynamic severity during follow-up. Multiple approaches to
estimate PAPM using DE have been previously
proposed.5-11 Most algorithms incorporate elements of
Doppler analysis obtained from tricuspid regurgitation
(TR),5 8 9 11 pulmonary regurgitation
(PR)7 or flow across the right ventricular outflow
tract (RVOT)6 12 into empirical relationships to
obtain PAPM. However, the accuracy of these approaches
to estimate invasive PAPM in the specific setting of
heart failure has not been studied. Further, current ESC recommendations
do not advise use of any DE algorithms to assess PAPMbut instead recommend the use of tricuspid regurgitation peak velocity
(TRVmax) cut-off >2.8m/sec to assign PH
probability.4 Availability of alternative
echocardiographic approaches that represent invasive
PAPM could potentially replace TRVmaxduring screening, and may even obviate the need for invasive assessment.
Studies directly comparing diagnostic performance of the recommended
TRVmax cut-off and echocardiographic
PAPM algorithms to identify PH are
few.13
With this background, we aimed to study the feasibility and accuracy of
4 different DE methods to estimate PAPM in a
retrospective analysis of HF subjects undergoing near-simultaneous RHC.
Further, we wished to compare the diagnostic performance of these
algorithms with recommendation-based TRVmax to identify
PH.