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
Right heart catheterization
Right ventricular systolic pressure
Tricuspid annular plane systolic excursion
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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.
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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