Echocardiography for the diagnosis of pulmonary vascular disease

Background: Echocardiography is a valid tool for predicting the presence of pre- or post-capillary pulmonary hypertension (PH). A diastolic pulmonary gradient (DPG) equal or higher than 7 mmHg is a marker of pulmonary vascular disease also in patients with post-capillary PH. Aim: To detect if an echocardiographic score is able to allow a differential diagnosis between isolated post-capillary PH (Ipc-PH) and combined post- and pre-capillary PH (Cpc-PH). Methods: An echo-score, including right-to-left-heart chamber dimension >1 (2 points), dilation and no collapsibility of inferior vena cava (2 points), left ventricular eccentricity index ≥1.2 (1 point), E/e9 ratio ≤10 (1 point), and the right ventricle forming the heart apex (1 point), was applied to 230 consecutive patients referred for evaluation of PH and quasi-simultaneous right heart catheterization RHC (within 1 hour). Results: One-hundred-sixty/230 (70%) patients had pre-capillary PH and 70/230 (30%) had post-capillary PH. Within the 70 patients with post-capillary PH, 51/70 had Ipc-PH and 19/70 had Cpc-PH. There was a moderate linear correlation between Echo score and DPG (R 2 = 0.34). Echo score was higher in pre- vs post-capillary PH patients (4.0±2.0 vs 1.6±1.8, p The sensitivity and the specificity of Echo score ≥3 for pre-capillary PH were respectively 74% and 73%. Considering the 70 patients with post-capillary PH, the sensitivity and the specificity of Echo score ≥3 for Cpc-PH were respectively 68% and 88%. Conclusions: Echocardiography allows a satisfactory differential diagnosis not only between pre- and post-capillary PH, but also between Ipc-PH and Cpc-PH.