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The value of ultrasound enhancing agents in the echocardiographic acquisition of pulmonary artery systolic pressure: An invasive to non-invasive correlation study

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Abstract

Purpose

Right heart catheterization (RHC) is the gold standard for the assessment of pulmonary artery systolic pressures (PASP). Despite high utilization of echocardiography for the non-invasive assessment of PASP, the data comparing real-time non-invasive echocardiographic PASP with invasive PASP is limited. Furthermore, evidence regarding the utility and diagnostic accuracy of ultrasound enhancing agents (UEA) for non-invasive PASP assessment is lacking. To evaluate the accuracy of non-invasive PASP assessment with real-time invasive measures and the incremental benefit of UEA in this setting.

Methods

This was a prospective cohort study of 90 patients, undergoing clinically indicated RHC for hemodynamic assessment. All patients underwent a limited echocardiogram during RHC. Tricuspid regurgitant velocity (TRV) was measured on unenhanced echo, in the setting of centrally administrated agitated saline, then as either centrally administered or peripherally administered UEA.

Results

Of the 90 patients enrolled in our study, 41% had pulmonary hypertension. The overall mean PASP measured by RHC was 32.8 mmHg (+/- 11.3 mmHg). Unenhanced echocardiograms had a moderate correlation with invasive PASP (r = 0.57; p = < 0.001) which improved to a strong correlation with administration of agitated saline (r = 0.75; p = < 0.001) or centrally administered UEA (r = 0.77; p = < 0.001), with the best correlation noted with peripherally administered UEA (r = 0.83; p = < 0.001). Against invasive PASP, agitated saline enhanced PASP had the lowest bias (0.12mmHg; -15.6 to 15.8mmHg) when compared with all other non-invasive measures of PASP.

Conclusions

Unenhanced echocardiographic estimation of TRV was found to have a poorer correlation with invasively measured PASP when compared to agitated saline and centrally administered UEA. Agitated saline enhanced PASP demonstrated the lowest bias with invasive PASP when compared to other non-invasive measures of PASP.

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Funding

This study was supported by a grant from GE HealthCare, and an unrestricted research grant from the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine.

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Authors and Affiliations

  1. Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA

    Vinesh Appadurai, Brody Slostad, Gregory J. Cascino, Tanvi Nayak & Bonnie Kane

  2. School of medicine, The University of Queensland, St Lucia, QLD, Australia

    Vinesh Appadurai

  3. Division of Cardiology, Loyola University Stritch School of Medicine, Chicago, IL, USA

    Menhel Kinno

  4. Northshore University Health System, Evanston, IL, USA

    Iva Minga

  5. University of Chicago Medical Center, Chicago, IL, USA

    Iva Minga

  6. Division of Cardiovascular Disease, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA

    Kameswari Maganti

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  1. Vinesh Appadurai
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Contributions

V.A., G.C., B.S., I.M. & K.M. analysed data and wrote the main manuscript; M.K., T.N. & B.K. collected data and helped create figures and reviewed final manuscript for editing. All authors reviewed manuscript.

Corresponding author

Correspondence to Kameswari Maganti.

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Disclosures

Kameswari Maganti, MD received research support from GE HealthCare, and Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine. Bonnie Kane was supported by a GE healthcare grant during the study. All the other authors have no disclosures to report.

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The authors declare no competing interests.

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Appadurai, V., Kinno, M., Minga, I. et al. The value of ultrasound enhancing agents in the echocardiographic acquisition of pulmonary artery systolic pressure: An invasive to non-invasive correlation study. Int J Cardiovasc Imaging 40, 821–830 (2024). https://doi.org/10.1007/s10554-024-03051-9

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