1. Investigating the value of right heart echocardiographic metrics for detection of pulmonary hypertension in patients with advanced lung disease.
- Author
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Amsallem M, Boulate D, Kooreman Z, Zamanian RT, Fadel G, Schnittger I, Fadel E, McConnell MV, Dhillon G, Mercier O, and Haddad F
- Subjects
- Adult, Aged, Animals, Animals, Newborn, Area Under Curve, Arterial Pressure, California, Catheterization, Swan-Ganz, Chi-Square Distribution, Cystic Fibrosis complications, Cystic Fibrosis diagnosis, Cystic Fibrosis physiopathology, Disease Models, Animal, Female, Humans, Hypertension, Pulmonary etiology, Hypertension, Pulmonary physiopathology, Hypertrophy, Right Ventricular etiology, Hypertrophy, Right Ventricular physiopathology, Logistic Models, Lung Diseases diagnosis, Lung Diseases physiopathology, Lung Diseases surgery, Lung Diseases, Interstitial complications, Lung Diseases, Interstitial diagnosis, Lung Diseases, Interstitial physiopathology, Lung Transplantation, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive physiopathology, ROC Curve, Registries, Reproducibility of Results, Risk Factors, Severity of Illness Index, Sus scrofa, Ventricular Dysfunction, Right etiology, Ventricular Dysfunction, Right physiopathology, Ventricular Remodeling, Echocardiography, Hypertension, Pulmonary diagnostic imaging, Hypertrophy, Right Ventricular diagnostic imaging, Lung Diseases complications, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Function, Right
- Abstract
This study determined whether novel right heart echocardiography metrics help to detect pulmonary hypertension (PH) in patients with advanced lung disease (ALD). We reviewed echocardiography and catheterization data of 192 patients from the Stanford ALD registry and echocardiograms of 50 healthy controls. Accuracy of echocardiographic right heart metrics to detect PH was assessed using logistic regression and area under the ROC curves (AUC) analysis. Patients were divided into a derivation (n = 92) and validation cohort (n = 100). Experimental validation was assessed in a piglet model of mild PH followed longitudinally. Tricuspid regurgitation (TR) was not interpretable in 52% of patients. In the derivation cohort, right atrial maximal volume index (RAVI), ventricular end-systolic area index (RVESAI), free-wall longitudinal strain and tricuspid annular plane systolic excursion (TAPSE) differentiated patients with and without PH; 20% of patients without PH had moderate to severe RV enlargement by RVESAI. On multivariate analysis, RAVI and TAPSE were independently associated with PH (AUC = 0.77, p < 0.001), which was confirmed in the validation cohort (0.78, p < 0.001). Presence of right heart metrics abnormalities did not improve detection of PH in patients with interpretable TR (p > 0.05) and provided moderate detection value in patients without TR. Only two patients with more severe PH (mean pulmonary pressure 35 and 36 mmHg) were missed. The animal model confirmed that right heart enlargement discriminated best pigs with PH from shams. This study highlights the frequency of right heart enlargement and dysfunction in ALD irrespectively from presence of PH, therefore limiting their use for detection of PH.
- Published
- 2017
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