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Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension.

Publication ,  Journal Article
Broderick-Forsgren, K; Davenport, CA; Sivak, JA; Hargett, CW; Foster, MC; Monteagudo, A; Armour, A; Rajagopal, S; Arges, K; Velazquez, EJ; Samad, Z
Published in: Int J Cardiovasc Imaging
September 2017

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.

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Published In

Int J Cardiovasc Imaging

DOI

EISSN

1875-8312

Publication Date

September 2017

Volume

33

Issue

9

Start / End Page

1341 / 1349

Location

United States

Related Subject Headings

  • Ventricular Pressure
  • Ventricular Function, Right
  • Ventricular Dysfunction, Right
  • Retrospective Studies
  • Reproducibility of Results
  • ROC Curve
  • Pulmonary Artery
  • Predictive Value of Tests
  • Nuclear Medicine & Medical Imaging
  • Models, Cardiovascular
 

Citation

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Broderick-Forsgren, K., Davenport, C. A., Sivak, J. A., Hargett, C. W., Foster, M. C., Monteagudo, A., … Samad, Z. (2017). Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension. Int J Cardiovasc Imaging, 33(9), 1341–1349. https://doi.org/10.1007/s10554-017-1114-2
Broderick-Forsgren, Kathleen, Clemontina A. Davenport, Joseph A. Sivak, Charles William Hargett, Michael C. Foster, Andrew Monteagudo, Alicia Armour, et al. “Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension.Int J Cardiovasc Imaging 33, no. 9 (September 2017): 1341–49. https://doi.org/10.1007/s10554-017-1114-2.
Broderick-Forsgren K, Davenport CA, Sivak JA, Hargett CW, Foster MC, Monteagudo A, et al. Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension. Int J Cardiovasc Imaging. 2017 Sep;33(9):1341–9.
Broderick-Forsgren, Kathleen, et al. “Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension.Int J Cardiovasc Imaging, vol. 33, no. 9, Sept. 2017, pp. 1341–49. Pubmed, doi:10.1007/s10554-017-1114-2.
Broderick-Forsgren K, Davenport CA, Sivak JA, Hargett CW, Foster MC, Monteagudo A, Armour A, Rajagopal S, Arges K, Velazquez EJ, Samad Z. Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension. Int J Cardiovasc Imaging. 2017 Sep;33(9):1341–1349.

Published In

Int J Cardiovasc Imaging

DOI

EISSN

1875-8312

Publication Date

September 2017

Volume

33

Issue

9

Start / End Page

1341 / 1349

Location

United States

Related Subject Headings

  • Ventricular Pressure
  • Ventricular Function, Right
  • Ventricular Dysfunction, Right
  • Retrospective Studies
  • Reproducibility of Results
  • ROC Curve
  • Pulmonary Artery
  • Predictive Value of Tests
  • Nuclear Medicine & Medical Imaging
  • Models, Cardiovascular