Clinical InvestigationPulmonary HypertensionEchocardiographic Prediction of Pre- versus Postcapillary Pulmonary Hypertension
Section snippets
Methods
In June 2011, we started a prospective study that lasted until May 2012, with two main purposes: (1) to compare invasive versus noninvasive measurements of the pulmonary circulation using rigorous Bland-Altman analysis, whose results have recently been published,10 and (2) to predict pre- versus postcapillary PH from echocardiographic measurements, which was the objective of the present study. One hundred twenty-two of 152 patients (80%) were included in two studies, and the same number of
Results
Nine of 161 patients (5.6%) were excluded from the study because of inadequate echocardiographic image quality. No patient showed echocardiographic signs of PH in the presence of estimated systolic PAP < 37 mm Hg. Demographics of the remaining 152 patients are summarized in Table 1; 81 of 152 patients (53%) had precapillary PH and 61 of 152 (40%) had postcapillary PH. Ten patients (7%) did not meet the diagnostic criteria for PH (mean PAP < 25 mm Hg on RHC).
Discussion
Our findings show that a simple echocardiographic score integrating measurements of right and left heart chamber dimensions with estimates of RV and LV filling pressures may discriminate between pre- and postcapillary PH with reasonable accuracy.
We aimed to develop a simple echocardiographic score on the basis of recommended measurements,3, 4 being realistic with respect to the daily clinical practice of most echocardiography laboratories. As a consequence, time-consuming performance indices,
Conclusions
Echocardiography should be part of the clinical evaluation reflecting the pathophysiology and left and right heart remodeling in different PH scenarios. We underscore the importance of some easy-to-measure and reproducible echocardiographic parameters, providing a simple rule able to predict the presence of pre- or postcapillary PH. Further investigations are needed to verify the reliability and the clinical effectiveness of this score in a larger patient population compared with “usual”
Acknowledgments
The authors are grateful to Mrs Antonella Nannolo for her contribution in this paper.
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