Abstract 14095: Role of Echocardiography for Screening of Pulmonary Hypertension in Patients With Advanced Lung Disease
Introduction: The screening performance of right heart metrics for pulmonary hypertension (PH) among patients with advanced lung disease (ALD) is not well established.
Hypothesis: We hypothesize that performance will be limited in this population.
Methods: We selected 192 patients from the prospectively built Stanford ALD registry, who were referred for echocardiography within 48 hours of catheterization, and 50 healthy controls. Patients were randomly divided in a derivation (n=92) and a validation cohort (n=100). In the first cohort, we determined the accuracy of echocardiographic right heart and flow metrics to detect PH (invasive mean pulmonary arterial pressure ≥25mmHg) using logistic regression and area under the ROC curves (AUC). We validated the results in the validation cohort and in an experimental cohort of large animals model of mild PH (n=4) and shams (n=4).
Results: Right atrial end-systolic volume index (RAVI), ventricular end-systolic area index (RVESAI), free-wall longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) best differentiated ALD patients with and without PH. On multivariate modeling, both RAVI and TAPSE were independently associated with PH (AUC=0.77); further confirmed in the validation cohort (0.78) (Figure 1) and irrespectively of the ALD etiology. In patients with ALD, prevalence of PH for maximal TR velocity values >3.4, ranging 3.4 to 2.9 and ≤2.8 m/s were 97%, 54% and 18%, respectively (p<0.001). Presence of right heart alteration improved risk stratification only when TR was not measurable. At least one echocardiographic metric of RV enlargement or dysfunction was found in 84% patients without PH. In piglets, RA and RV end-systolic size best discriminated PH (p<0.03).
Conclusions: This study highlights the limitations of right heart and pulmonary flow metrics for screening of PH in ALD, because of the frequent right heart enlargement or dysfunction regardless of the presence of PH.
Author Disclosures: M. Amsallem: None. D. Boulate: None. Z. Kooreman: None. R. Zamanian: None. G. Fadel: None. I. Schnittger: None. E. Fadel: None. G. Dhillon: None. M.V. McConnell: None. O. Mercier: None. F. Haddad: None.
- © 2016 by American Heart Association, Inc.