Slegg Oliver Graham, Willis James Alexander, Wilkinson Fiona, Sparey Joseph, Wild Christopher Basil, Rossdale Jennifer, Ross Robert Mackenzie, Pauling John D, Carson Kevin, Kandan Sri Raveen, Oxborough David, Knight Daniel, Peacock Oliver James, Suntharalingam Jay, Coghlan John Gerard, Augustine Daniel Xavier
Royal United Hospitals Bath NHS Foundation Trust, Bath, BA13NG, UK.
School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
Echo Res Pract. 2022 Oct 19;9(1):9. doi: 10.1186/s44156-022-00010-9.
The world symposium on pulmonary hypertension (PH) has proposed that PH be defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg as assessed by right heart catheterisation (RHC). Transthoracic echocardiography (TTE) is an established screening tool used for suspected PH. International guidelines recommend a multi-parameter assessment of the TTE PH probability although effectiveness has not been established using real world data.
To determine accuracy of the European Society of Cardiology (ESC) and British Society of Echocardiography (BSE) TTE probability algorithm in detecting PH in patients attending a UK PH centre. To identify echocardiographic markers and revised algorithms to improve the detection of PH in those with low/intermediate BSE/ESC TTE PH probability.
TTE followed by RHC (within 4 months after) was undertaken in patients for suspected but previously unconfirmed PH. BSE/ESC PH TTE probabilities were calculated alongside additional markers of right ventricular (RV) longitudinal and radial function, and RV diastolic function. A refined IMPULSE algorithm was devised and evaluated in patients with low and/or intermediate ESC/BSE TTE PH probability.
Of 310 patients assessed, 236 (76%) had RHC-confirmed PH (average mPAP 42.8 ± 11.7). Sensitivity and specificity for detecting PH using the BSE/ESC recommendations was 89% and 68%, respectively. 36% of those with low BSE/ESC TTE probability had RHC-confirmed PH and BSE/ESC PH probability parameters did not differ amongst those with and without PH in the low probability group. Conversely, RV free wall longitudinal strain (RVFWLS) was lower in patients with vs. without PH in low BSE/ESC probability group (- 20.6 ± 4.1% vs - 23.8 ± 3.9%) (P < 0.02). Incorporating RVFWLS and TTE features of RV radial and diastolic function (RVFAC and IVRT) within the IMPULSE algorithm reduced false negatives in patients with low BSE/ESC PH probability by 29%. The IMPULSE algorithm had excellent specificity and positive predictive value in those with low (93%/80%, respectively) or intermediate (82%/86%, respectively) PH probability.
Existing TTE PH probability guidelines lack sensitivity to detect patients with milder haemodynamic forms of PH. Combining additional TTE makers assessing RV radial, longitudinal and diastolic function enhance identification of milder forms of PH, particularly in those who have a low BSE/ESC TTE PH probability.
世界肺动脉高压（PH）研讨会提出，PH的定义为经右心导管检查（RHC）评估的平均肺动脉压（mPAP）>20mmHg。经胸超声心动图（TTE）是用于疑似PH的既定筛查工具。国际指南建议对TTE诊断PH的可能性进行多参数评估，尽管尚未使用真实世界数据证实其有效性。
确定欧洲心脏病学会（ESC）和英国超声心动图学会（BSE）的TTE诊断概率算法在检测英国PH中心患者的PH时的准确性。识别超声心动图标志物和修订算法，以改善对BSE/ESC TTE诊断PH可能性低/中等的患者中PH的检测。
对疑似但先前未确诊PH的患者进行TTE检查，随后在4个月内进行RHC检查。计算BSE/ESC PH TTE诊断概率以及右心室（RV）纵向和径向功能及RV舒张功能的其他标志物。针对ESC/BSE TTE诊断PH可能性低和/或中等的患者设计并评估了一种改进的IMPULSE算法。
在评估的310例患者中，236例（76%）经RHC确诊为PH（平均mPAP 42.8±11.7）。使用BSE/ESC建议检测PH的敏感性和特异性分别为89%和68%。BSE/ESC TTE诊断可能性低的患者中，36%经RHC确诊为PH，低可能性组中有无PH患者的BSE/ESC PH诊断概率参数无差异。相反，在BSE/ESC诊断可能性低的组中，有PH的患者与无PH的患者相比，右心室游离壁纵向应变（RVFWLS）较低（-20.6±4.1%对-23.8±3.9%）（P<0.02）。在IMPULSE算法中纳入RVFWLS以及RV径向和舒张功能的TTE特征（RVFAC和IVRT），可使BSE/ESC PH诊断可能性低的患者中假阴性减少29%。IMPULSE算法在PH诊断可能性低（分别为93%/80%）或中等（分别为82%/86%）的患者中具有出色的特异性和阳性预测值。
现有的TTE诊断PH可能性指南在检测较轻血流动力学形式的PH患者时缺乏敏感性。结合评估RV径向、纵向和舒张功能的额外TTE指标可增强对较轻形式PH的识别，特别是在BSE/ESC TTE诊断PH可能性低的患者中。
