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Echocardiographic evaluation of left ventricular filling pressures in patients with pulmonary hypertension
Hong Ran1, Matthias Schneider2, Anna Maria Pistritto3
1Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Insights
The 2016 echocardiography guidelines more accurately estimate left ventricular filling pressures in pulmonary hypertension patients than the 2009 guidelines. This improved accuracy aids in diagnosing diastolic dysfunction in this population.
Area of Science:
- Cardiology
- Echocardiography
- Pulmonary Hypertension
Background:
- Echocardiographic assessment of diastolic dysfunction relies on surrogate parameters.
- Current guidelines use diagnostic flowcharts to classify left ventricular filling pressures (LVFP).
- The accuracy of these tools can be limited by non-diastolic causes of elevated surrogate parameters, such as in pulmonary hypertension (PH).
Purpose of the Study:
- To compare the diagnostic accuracy of the 2009 and 2016 echocardiographic guideline recommendations for assessing diastolic function.
- To evaluate the effectiveness of these guidelines in estimating left ventricular filling pressures (LVFP) specifically in patients with pulmonary hypertension (PH).
Main Methods:
- Retrospective analysis of 101 consecutive patients undergoing right heart catheterization and echocardiography for suspected PH.
- Inclusion of 63 PH patients in the final analysis.
- Application of both 2009 and 2016 echocardiographic guideline recommendations for diastolic function assessment.
Main Results:
- The 2016 recommendations showed higher sensitivity (84%) and similar specificity (80%) compared to the 2009 recommendations (67% sensitivity, 82% specificity).
- The area under the receiver operating characteristic curve (AUC) for the 2016 guidelines (0.82) was significantly better than for the 2009 guidelines (0.74) (p=0.04).
- 43% of the included PH patients had elevated LVFP.
Conclusions:
- The 2016 echocardiographic guidelines demonstrate superior accuracy in estimating LVFP in patients with PH compared to the 2009 guidelines.
- Updated guidelines improve the diagnostic capability for diastolic dysfunction in the context of pulmonary hypertension.
- These findings support the adoption of the 2016 recommendations for improved clinical decision-making in PH patients.
Abstract:
Echocardiographic assessment of diastolic dysfunction depends on surrogate parameters. In recent years, guideline committees attempted to combine these parameters to diagnostic flowcharts allowing for correct classification of left ventricular filling pressures (LVFP). The value of these diagnostic tools is limited if the applied surrogate parameters are elevated due to other reasons as is the case with maximal tricuspid regurgitation velocity. We aimed to compare the accuracy of the 2009 and the 2016 guideline recommendations in patients with pulmonary hypertension (PH). We included 101 consecutive patients who underwent right heart catheterization and transthoracic echocardiography for suspicion of PH. For the final analysis, only patients with PH were considered. The 2009 and 2016 recommendations for the assessment of diastolic function by echocardiography were applied on each patient. A total of 63 PH patients were included in the final analysis, 43% had elevated LVFP. By using the 2009 recommendations, sensitivity for correct classification of diastolic dysfunction was 67%, specificity was 82%, area under the curve (AUC) was 0.74. By using the 2016 recommendations, sensitivity for correct classification of diastolic dysfunction was 84%, specificity was 80%, AUC was 0.82. In ROC comparison, the AUC for the 2016 recommendations with 0.82 was significantly better compared to the AUC of 0.74 for the 2009 recommendations (p = 0.04). Our study demonstrates that the 2016 recommendations for echocardiographic evaluation of diastolic function are superior to the 2009 recommendations in estimating left ventricular filling pressures in patients with PH.
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