Related Experiment Video
Updated: Feb 20, 2026
Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery
Published on: February 20, 2017
Performance of Guideline-Recommended Approaches to Echocardiographic Investigation for Pulmonary Hypertension:
Luke S Howard1, David G Kiely2, Allan Lawrie3
1National Pulmonary Hypertension Service, Hammersmith Hospital London UK.
Insights
Transthoracic echocardiography (TTE) effectively detects pulmonary hypertension (PH) using either the 2015 ESC/ERS algorithm or RVSP > 40 mmHg. Both methods show similar sensitivity and specificity for PH diagnosis.
Area of Science:
- Cardiology
- Pulmonology
- Medical Imaging
Background:
- Pulmonary hypertension (PH) diagnosis relies on various transthoracic echocardiography (TTE) methods.
- Guidelines offer differing TTE approaches for PH investigation.
- Accurate non-invasive PH detection is crucial for timely management.
Purpose of the Study:
- To prospectively evaluate TTE detection of PH using two distinct algorithms.
- To compare the diagnostic performance of the 2015 ESC/ERS TTE algorithm against RVSP > 40 mmHg.
- To assess the effectiveness of TTE in identifying PH in patients referred for right heart catheterization.
Main Methods:
- Prospective evaluation of 475 patients referred to PH clinics undergoing TTE and RHC.
- Classification of PH probability using the 2015 ESC/ERS TTE algorithm.
- Classification of PH probability using RVSP > 40 mmHg.
- Performance measured against RHC-confirmed PH (mean pulmonary artery pressure > 20 mmHg).
Main Results:
- 345 patients (73%) had confirmed PH.
- The ESC/ERS algorithm yielded high, intermediate, low, and non-assessable probabilities in 198, 104, 22, and 151 patients, respectively.
- Sensitivity and specificity were comparable between the two TTE methods (79%-77% and 78%-79%, respectively).
- 42% of patients classified as low-probability or non-assessable by ESC/ERS algorithm had PH.
Conclusions:
- Both the 2015 ESC/ERS TTE algorithm and RVSP > 40 mmHg demonstrate similar diagnostic performance for PH.
- A significant proportion of patients with low-probability or non-assessable TTE findings have PH, indicating a need for improved non-invasive tools.
- Further research into advanced non-invasive methods is warranted to enhance PH detection accuracy.
Abstract:
Guidelines recommend different approaches to investigate for pulmonary hypertension (PH) by transthoracic echocardiography (TTE). We used data from the CIPHER study (NCT04193046) to prospectively evaluate TTE detection of PH. Participants newly referred to PH clinics who underwent right heart catheterization (RHC) within 6 weeks and TTE within 60 days of enrolment (blinded central TTE reading) were classified by TTE probability of PH applying (i) the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) TTE algorithm or (ii) right ventricular systolic pressure (RVSP) > 40 mmHg. For calculation of sensitivity and specificity, 'non-assessable' patients (peak tricuspid regurgitation velocity [TRV] missing or ≤ 2.8 m/s with missing data on other echocardiographic signs) and patients with missing RVSP were counted as PH-negative. Performance was measured against RHC-confirmed diagnosis of mean pulmonary artery pressure > 20 mmHg. Of 475 patients included, 345 (73%) had PH. Using the ESC/ERS algorithm, PH probability was high, intermediate, low and non-assessable for 198, 104, 22 and 151 patients and PH prevalence was 98%, 75%, 23%, and 44%, respectively. Seventy-three patients were missing RVSP and 292 had RVSP > 40 mmHg. The two TTE approaches achieved similar results: sensitivity was 79%-77%, specificity was 78%-79%. This prospective study of patients newly referred to PH centres for RHC found similar sensitivity and specificity when using either RVSP > 40 mmHg or the 2015 ESC/ERS TTE algorithm. Among patients who were low-probability or non-assessable by ESC/ERS algorithm, 42% had PH, highlighting the persistent need for additional non-invasive investigative tools.
Related Concept Videos
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...