SPC365

Noninvasive measurement of mean pulmonary artery pressure through echocardiography – is it a reliable alternative?

Session: Sessão de Posters 05 - Ecocardiografia
Speaker: Daniel Inácio Cazeiro

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Cartazes
FP Number: ---
Authors: Daniel Inácio Cazeiro; Miguel Azaredo Raposo; Catarina Simões de Oliveira; Ana Beatriz Garcia; Ana Margarida Martins; Ana Abrantes; Sara Prata; Tatiana Guimarães; Catarina Sousa; Ana G. Almeida; Fausto J. Pinto; Rui Plácido

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: In the diagnostic algorithm of pulmonary hypertension (PH), echocardiography plays a fundamental role regarding initial assessment of its probability. Subsequent diagnosis should be confirmed by right heart catheterization (RHC) and is defined as a mean pulmonary artery pressure (mPAP) &gt; 20mmHg. However, there are several formulas which can be used to noninvasively estimate mPAP through echocardiography.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To analyze the accuracy of noninvasive echocardiographic measurement of mPAP and ability to predict PH severity.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Retrospective single-center study including patients who were submitted to echocardiogram and RHC on the same day, from 2021 to 2023. Hemodynamic parameters from RHC were collected from the patients&rsquo; (pts) records. Echocardiograms were reviewed and three formulas were used to estimate mPAP: (mPAP1) 0.61 * estimated pulmonary artery systolic pressure + 2; (mPAP2) 90&ndash;0.62 * pulmonary acceleration time and (mPAP3) tricuspid regurgitation mean gradient + estimated right atrial pressure. Pearson tests were used to assess the correlation between RHC and echocardiographic mPAP. Receiving operating characteristic analysis was used to assess the performance of echocardiographic mPAP in predicting severe PH, here defined as RHC mPAP &gt;45 mmHg or pulmonary vascular resistance (PVR) &gt;5 Wood units (WU).</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: A total of 73 pts were included (64.4% female), with a mean age of 63.5 years. Mean mPAP was 39.5 mmHg and median PVR was 6.5 WU, measured by RHC. When measured by echocardiography, mean mPAP1, mPAP2 and mPAP3 values were 39.7, 39.0 and 37.5 mmHg, respectively. A strong correlation was found between RHC mPAP and mPAP1 (r=0.768, p&lt;0.001), as well as mPAP3 (r=0.792, p&lt;0.001). Correlation between RHC mPAP and mPAP2 was moderate (r=0.468, p&lt;0.001).&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The highest sensitivity and specificity for predicting RHC mPAP &gt;45 mmHg was achieved with mPAP1 and mPAP3 values of 38.9 and 41.5 mmHg, respectively. Although specificity for predicting PVR &gt;5 WU was low with both mPAP1 and mPAP3, values &lt;27.8 and &lt;25.9 mmHg were 100% sensitive for excluding severe PH, respectively.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Noninvasive echocardiographic measurement of mPAP through the mPAP1 and mPAP3 formulas showed good correlation with RHC mPAP, and values &gt;38.9 and &gt;41.5 mmHg revealed reasonable diagnostic accuracy for predicting severe PH. Measurement of noninvasive mPAP might also prove useful as a screening tool to exclude high PVR.</span></span></span></p>

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