The International Journal of Cardiovascular Imaging

, Volume 33, Issue 9, pp 1341–1349 | Cite as

Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension

  • Kathleen Broderick-Forsgren
  • Clemontina A. Davenport
  • Joseph A. Sivak
  • Charles William Hargett
  • Michael C. Foster
  • Andrew Monteagudo
  • Alicia Armour
  • Sudarshan Rajagopal
  • Kristine Arges
  • Eric J. Velazquez
  • Zainab SamadEmail author
Original Paper


This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC = 0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.


Diagnostic characteristics Echocardiogram Pulmonary hypertension Right ventricular systolic pressure (RVSP) 



American Society of Echocardiography


Area under the curve




Pulmonary artery


Pulmonary hypertension


Right atrial


Right heart catheterization


Right ventricle


Right ventricular systolic pressure


Transthoracic echocardiography


Tricuspid annular plane systolic excursion



This work was supported internally by a Duke Resident Research Award.


Broderick-Forsgren: none; Dr. Davenport has research grant support from Duke CTSA (UL1TR001117)., Sivak: none; Hargett: none; Foster: none; Monteagudo: none; Armour: none; Rajagopal: Research grants from NHLBI (NIHKO8), Gilead, Burroughs-Wellcome Trust; Advisory board: Gilead; Arges: none; Velazquez: Research grants from NHLBI, Ikaria Pharmaceuticals, Consulting Fees/Honoraria: Novartis Pharmaceuticals Corp., Research grants for NIH and Abbott-Vascular. He serves as an advisor for Alnylam Incorporated and Novartis; Samad: Research grant support from Gilead, Boston Scientific, NHLBI and American Society of Echocardiography.

Compliance with ethical standards

Conflict of interest

Dr. Broderick-Forsgren, Dr. Sivak, Dr. Hargett, Mr. Foster, Mr. Monteagudo, Dr. Rajagopal, and Ms. Arges have no relevant conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were 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. For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Kathleen Broderick-Forsgren
    • 1
  • Clemontina A. Davenport
    • 2
  • Joseph A. Sivak
    • 3
  • Charles William Hargett
    • 4
  • Michael C. Foster
    • 5
  • Andrew Monteagudo
    • 5
  • Alicia Armour
    • 5
  • Sudarshan Rajagopal
    • 3
  • Kristine Arges
    • 5
  • Eric J. Velazquez
    • 3
    • 5
  • Zainab Samad
    • 3
    • 5
    Email author
  1. 1.Duke Medicine Residency Program, Department of MedicineDuke University HospitalDurhamUSA
  2. 2.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  3. 3.Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamUSA
  4. 4.Division of Pulmonary, Allergy, and Critical Care MedicineDuke University Medical CenterDurhamUSA
  5. 5.Cardiac Diagnostic UnitDuke University Medical CenterDurhamUSA

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