The Diagnostic Value of Transthoracic Echocardiography Parameters Under the New Diagnostic Criteria for Pulmonary Hypertension

TL;DR

This study evaluates how well echocardiography parameters can diagnose pulmonary hypertension under new 2022 guidelines that lowered the pressure threshold.

Contribution

The study identifies updated optimal cutoff values for echocardiography parameters under the revised PH diagnostic criteria.

Findings

RVOT-AT < 93 ms was a strong predictor of PH regardless of tricuspid regurgitation velocity measurements.

Combining RVOT-AT < 93 ms, main pulmonary artery diameter > 25 mm, and RAA > 14.5 cm² improved diagnostic specificity.

Adjusting TAPSE/sPAP, RVOT-AT, and RAA thresholds improved PH prediction under the new criteria.

Abstract

In 2022, new guidelines for the diagnosis and treatment of pulmonary hypertension (PH) revised the hemodynamic definition, reducing the mean pulmonary artery pressure threshold from ≥ 25 to > 20 mmHg. The optimal threshold of transthoracic echocardiography (TTE) parameters and the predictive capability require further validation. This study aims to investigate the diagnostic value of TTE parameters under the new hemodynamic criteria.

Retrospective analysis of PH patients who underwent right heart catheterization and TTE examination between 2017 and 2022 in a single center. Logistic regression was employed to ascertain the predictive capacity of parameters across various conditions. Receiver operating characteristic curves were used to determine the optimal cutoff values based on the new criteria.

In a cohort of 213 patients, the optimal cutoff values identified were a tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary arterial pressure (sPAP) ratio of < 0.50 mm/mmHg, a right ventricular outflow tract acceleration time (RVOT-AT) of < 93 ms, and a right atrial area (RAA) > of 14.5 cm2. Regardless of the inclusion of tricuspid regurgitation velocity (TRV) and related parameters, RVOT-AT < 93 ms manifested as an effective predictive parameter. A combination of RVOT-AT < 93 ms, main pulmonary artery diameter > 25 mm and RAA > 14.5 cm2 exhibited better specificity.

The threshold values for TAPSE/sPAP, RVOT-AT, and RAA should be adjusted to improve the predictive capacity of PH based on revised criteria in this single-center dataset. RVOT-AT was a promising indirect parameter, and the utilization of combined indirect indicators may enhance diagnostic accuracy, particularly in instances where satisfactory TRV measurements are unavailable.

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