Michele D'Alto1, Emanuele Romeo2, Paola Argiento2, Adriana Pavelescu3, Christian Mélot4, Antonello D'Andrea2, Anna Correra2, Eduardo Bossone5, Raffaele Calabrò2, Maria G Russo2, Robert Naeije6. 1. Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy. Electronic address: mic.dalto@tin.it. 2. Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy. 3. Department of Cardiology, Molière Longchamp Hospital, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Emergency, Erasme Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium. 5. Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana," Salerno, Italy. 6. Department of Physiology, Faculty of Medicine, Erasme Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Abstract
BACKGROUND: The differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) is of major therapeutic relevance and thus requires optimal clinical probability assessment with echocardiography. METHODS: We prospectively analyzed 152 consecutive patients referred to a PH center over a 1-year period undergoing quasi-simultaneous (within 1 hour) echocardiography and right heart catheterization. Echocardiography was performed as usually recommended for the assessment of PH and left heart conditions. PH was defined as a mean pulmonary artery pressure ≥ 25 mm Hg. Postcapillary PH was diagnosed on the basis of a pulmonary capillary wedge pressure >15 mm Hg. RESULTS: Ten of 152 patients (7%) had no PH, 81 of 152 (53%) had precapillary PH, and 61 of 152 (40%) had postcapillary PH. The following five echocardiographic variables were found to predict precapillary PH: right heart chamber larger than the left (P = .0018), left ventricular eccentricity index > 1.2 (P = .0039), dilated inferior vena cava without inspiratory collapse (P = .0076), E/e' ratio ≤ 10 (P = .00001), and the right ventricle forming the heart apex (P = .0144). Beta coefficients from multiple logistic regression were significant for dilated inferior vena cava without inspiratory collapse (P = .0464) and E/e' ratio ≤ 10 (P = .0002). The score based on β coefficients, ranging from 3 to 34 points, resulted in optimal discrimination at >5, with a positive predictive value of 67.9% and a negative predictive value of 77.5% for precapillary PH. CONCLUSION: Echocardiography enables a clinically satisfactory differential diagnosis between pre- and postcapillary PH.
RCT Entities:
BACKGROUND: The differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) is of major therapeutic relevance and thus requires optimal clinical probability assessment with echocardiography. METHODS: We prospectively analyzed 152 consecutive patients referred to a PH center over a 1-year period undergoing quasi-simultaneous (within 1 hour) echocardiography and right heart catheterization. Echocardiography was performed as usually recommended for the assessment of PH and left heart conditions. PH was defined as a mean pulmonary artery pressure ≥ 25 mm Hg. Postcapillary PH was diagnosed on the basis of a pulmonary capillary wedge pressure >15 mm Hg. RESULTS: Ten of 152 patients (7%) had no PH, 81 of 152 (53%) had precapillary PH, and 61 of 152 (40%) had postcapillary PH. The following five echocardiographic variables were found to predict precapillary PH: right heart chamber larger than the left (P = .0018), left ventricular eccentricity index > 1.2 (P = .0039), dilated inferior vena cava without inspiratory collapse (P = .0076), E/e' ratio ≤ 10 (P = .00001), and the right ventricle forming the heart apex (P = .0144). Beta coefficients from multiple logistic regression were significant for dilated inferior vena cava without inspiratory collapse (P = .0464) and E/e' ratio ≤ 10 (P = .0002). The score based on β coefficients, ranging from 3 to 34 points, resulted in optimal discrimination at >5, with a positive predictive value of 67.9% and a negative predictive value of 77.5% for precapillary PH. CONCLUSION: Echocardiography enables a clinically satisfactory differential diagnosis between pre- and postcapillary PH.
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