Investigating the value of right heart echocardiographic metrics for detection of pulmonary hypertension in patients with advanced lung disease
- 223 Downloads
This study determined whether novel right heart echocardiography metrics help to detect pulmonary hypertension (PH) in patients with advanced lung disease (ALD). We reviewed echocardiography and catheterization data of 192 patients from the Stanford ALD registry and echocardiograms of 50 healthy controls. Accuracy of echocardiographic right heart metrics to detect PH was assessed using logistic regression and area under the ROC curves (AUC) analysis. Patients were divided into a derivation (n = 92) and validation cohort (n = 100). Experimental validation was assessed in a piglet model of mild PH followed longitudinally. Tricuspid regurgitation (TR) was not interpretable in 52% of patients. In the derivation cohort, right atrial maximal volume index (RAVI), ventricular end-systolic area index (RVESAI), free-wall longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) differentiated patients with and without PH; 20% of patients without PH had moderate to severe RV enlargement by RVESAI. On multivariate analysis, RAVI and TAPSE were independently associated with PH (AUC = 0.77, p < 0.001), which was confirmed in the validation cohort (0.78, p < 0.001). Presence of right heart metrics abnormalities did not improve detection of PH in patients with interpretable TR (p > 0.05) and provided moderate detection value in patients without TR. Only two patients with more severe PH (mean pulmonary pressure 35 and 36 mmHg) were missed. The animal model confirmed that right heart enlargement discriminated best pigs with PH from shams. This study highlights the frequency of right heart enlargement and dysfunction in ALD irrespectively from presence of PH, therefore limiting their use for detection of PH.
KeywordsEchocardiography Lung disease Pulmonary hypertension Right heart failure Strain
The authors would like to thank the Stanford Cardiovascular Institute and Vera Moulton Wall Center of Pulmonary Hypertension at Stanford for their support.
This study was funded by the Stanford Cardiovascular Institute, the Vera Moulton Wall Center of Pulmonary Hypertension at Stanford and the French National Reseach Agency (ANR-15-RHUS-0002).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest. MA received a Young Investigator Seed Grant from the Vera Moulton Wall Center. MVM previously received cardiac MRI research support from GE Healthcare and is currently on partial leave of absence while at Verily. FH received funds from Pai Chan Lee Research fund.
All applicable international, national, and/or institutional guidelines for the care and use of animals were followed (Institutional Animal Care Committee of Marie Lannelongue Hospital, Paris-Sud University, France). All procedures performed in studies involving human participants were approved by Stanford University Institutional Review Board in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- 1.Galiè N, Humbert M, Vachiery J-L, Gibbs S, et al. (2015) ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J 46:903–975.CrossRefPubMedGoogle Scholar
- 10.McLaughlin VV, Archer SL, Badesch DB et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation 119:2250–2294CrossRefPubMedGoogle Scholar
- 11.Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–788CrossRefPubMedGoogle Scholar