ABSTRACT
BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms
have been proposed to estimate mean pulmonary artery pressure
(PAPM) and assess pulmonary hypertension (PH)
likelihood. We assessed the accuracy of 4 different DE approaches to
estimate PAPM in patients with heart failure (HF)
undergoing near-simultaneous right heart catheterization (RHC), and
compared their diagnostic performance to identify PH with
recommendation-advised tricuspid regurgitation peak velocity
(TRVmax).
METHODS. PAPM was retrospectively assessed in
112 HF patients employing 4 previously validated DE algorithms.
Association and agreement with invasive PAPM were
assessed. Diagnostic performance of DE methods vs.
TRVmax=2.8m/sec to identify invasive
PAPM ≥ 25mmHg were compared.
RESULTS. All DE algorithms demonstrated reasonable association
(r = 0.41 to 0.65; p<0.001) and good agreement with invasive
PAPM, with relatively lower mean bias and higher
precision observed in algorithms that included TRVmax or
velocity time integral. All methods demonstrated strong ability
(AUC=0.70-0.80; p<0.001) to identify PH but did not outperform
TRVmax (AUC=0.84; p<0.001). Echocardiographic
estimates of right atrial pressure were considered in 3 of 4 DE
algorithms and falsely elevated in as many as 30% of patients.
CONCLUSIONS . Echocardiographic estimates of
PAPM demonstrate reasonable accuracy to represent
invasive PAPM and strong ability to identify PH in HF.
However, even the best performing algorithm did not outperform
recommendation-advised TRVmax. The additional value of
echocardiographic estimates of right atrial pressure may need to be
re-evaluated.