Document Detail


A simple echocardiographic prediction rule for hemodynamics in pulmonary hypertension.
MedLine Citation:
PMID:  22914595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary hypertension (PH) has diverse causes with heterogeneous physiology compelling distinct management. Differentiating patients with primarily elevated pulmonary vascular resistance (PVR) from those with PH predominantly because of elevated left-sided filling pressure is critical.
METHODS AND RESULTS: We reviewed hemodynamics, echocardiography, and clinical data for 108 patients seen at a referral PH clinic with transthoracic echocardiogram and right heart catheterization within 1 year. We derived a simple echocardiographic prediction rule to allow hemodynamic differentiation of PH attributed to pulmonary vascular disease (PH(PVD), defined as pulmonary artery wedge pressure [PAWP]≤15 mm Hg and PVR>3 WU). Age averaged 61.3±14.8 years, μPAWP and PVR were 16.4±7.1 mm Hg and 6.3±4.0 WU, respectively, and 52 (48.1%) patients fulfilled PH(PVD) hemodynamic criteria. The derived prediction rule ranged from -2 to +2 with higher scores suggesting higher probability of PH(PVD): +1 point for left atrial anterior-posterior dimension <3.2 cm; +1 for presence of a mid systolic notch or acceleration time <80 ms; -1 for lateral mitral E:e'>10; -1 for left atrial anterior-posterior dimension >4.2 cm. PVR increased stepwise with score (for -2, 0, and +2, μPVR were 2.5, 4.5, and 8.1 WU, respectively), whereas the inverse was true for pulmonary artery wedge pressure (corresponding μPAWP were 21.5, 16.5, and 10.4 mm Hg). Among subjects with complete data, the score had an area under the curve (AUC) of 0.921 for PH(PVD). A score ≥0 had 100% sensitivity and 69.3% positive predictive value for PH(PVD), with 62.3% specificity. No patients with a negative score had PH(PVD). Patients with a negative score and acceleration time >100 ms had normal PVR (μPVR=1.8 WU, range=0.7-3.2 WU).
CONCLUSIONS: We present a simple echocardiographic prediction rule that accurately defines PH hemodynamics, facilitates improved screening and focused clinical investigation for PH diagnosis and management.
Authors:
Alexander R Opotowsky; Jason Ojeda; Frances Rogers; Vikram Prasanna; Mathieu Clair; Lilamarie Moko; Anjali Vaidya; Jonathan Afilalo; Paul R Forfia
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-08-22
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  5     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-21     Completed Date:  2013-01-22     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  765-75     Citation Subset:  IM    
Affiliation:
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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MeSH Terms
Descriptor/Qualifier:
Echocardiography / methods*
Female
Follow-Up Studies
Hemodynamics / physiology*
Humans
Hypertension, Pulmonary / physiopathology,  ultrasonography*
Male
Middle Aged
Predictive Value of Tests
Reproducibility of Results
Retrospective Studies
Grant Support
ID/Acronym/Agency:
5-T32-HL07604-25/HL/NHLBI NIH HHS; T32 HL007604/HL/NHLBI NIH HHS; UL1-RR-025758/RR/NCRR NIH HHS
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