Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension

被引:10
作者
Broderick-Forsgren, Kathleen [1 ]
Davenport, Clemontina A. [2 ]
Sivak, Joseph A. [3 ]
Hargett, Charles William [4 ]
Foster, Michael C. [5 ]
Monteagudo, Andrew [5 ]
Armour, Alicia [5 ]
Rajagopal, Sudarshan [3 ]
Arges, Kristine [5 ]
Velazquez, Eric J. [3 ,5 ]
Samad, Zainab [3 ,5 ]
机构
[1] Duke Univ Hosp, Dept Med, Duke Med Residency Program, Durham, NC USA
[2] Duke Univ, Med Ctr, Dept Biostat & Bioinformat, Durham, NC USA
[3] Duke Univ, Med Ctr, Dept Med, Div Cardiol, Rm 3347A, Durham, NC 27710 USA
[4] Duke Univ, Med Ctr, Div Pulm Allergy & Crit Care Med, Durham, NC USA
[5] Duke Univ, Med Ctr, Cardiac Diagnost Unit, Durham, NC 27708 USA
基金
英国惠康基金;
关键词
Diagnostic characteristics; Echocardiogram; Pulmonary hypertension; Right ventricular systolic pressure (RVSP); ARTERY SYSTOLIC PRESSURE; EUROPEAN-ASSOCIATION; AMERICAN-SOCIETY; RIGHT HEART; CATHETERIZATION; PREDICTORS; GUIDELINES; CARDIOLOGY; BRANCH;
D O I
10.1007/s10554-017-1114-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1341 / 1349
页数:9
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