| Objective The aim of this study was to analyze the reliability of noninvasive right atrium area(RAA),tricuspid regurgitation pressure gradient(TRPG),pulmonary artery pressure(PAP),right atrial pressure(RAP),pulmonary vascular resistance(PVR)and pulmonary capillary wedge pressure(PCWP)assessments by Doppler echocardiography(DE)compared to invasive measurements by right heart catheterization(RHC)in a prospectively large population and to evaluate the value of Doppler echocardiography in estimating pulmonary artery pressure and diagnosing pulmonary hypertension.Methods We prospectively identified 325 consecutive patients who might be diagnosed as pulmonary hypertension(PH)and who subsequently underwent both RHC and DE between May 2019 and September 2020 in Gansu Provincial Hospital.Excluded the insufficient quality of the ultrasound image,no measurable tricuspid regurgitation jet,patients with pulmonary valve stenosis and patients with VSD(ventricular septal defect)or PDA(patent ductus arteriosus).Finally,272 subjects were included in this clinical study.We performed linear regression analysis for those assessments by DE with respective invasive measurements by RHC.We also conducted ROC analysis to evaluate the accuracy and specificity of those noninvasive assessments by DE to diagnose PH(defined as PAP ≥ 25 mm Hg or PVR(29)3 Wood Units)and pulmonary arterial hypertension(PAH)(defined as satisfying at the same time: mean PAP ≥ 25 mm Hg,PCWP ≤ 15 mm Hg and PVR(29)3 Wood Units)and get their cut-off values.Results In total,87.5% of these 272 patients had PH.In addition to PCWP,the rest of noninvasive assessments mentioned above by DE is both related with respective invasive measurements by RHC and there is a relatively good correlation for s PAP,m PAP and TRPG,the R values of these three noninvasive assessments are0.78,0.75,0.78,respectively.The results of ROC analysis showed that all the DE measurement values mentioned above,except for PCWP,the remaining DE measurements all could be used to diagnose PH,sensitivity(76.4%)and specificity(93.6%)for a s PAP cut-off value of 59.5 mm Hg(AUC 0.916,P < 0.0001),sensitivity(76.7%)and specificity(100.0%)for a m PAP cut-off value of 37.5 mm Hg(AUC0.946,P < 0.001),sensitivity(69.8%)and specificity(86.2%)for a d PAP cut-off value of 24.75 mm Hg(AUC 0.821,P < 0.001),sensitivity(84.3%)and specificity(92.6%)for a PVR cut-off value of 4.2 Wood Units(AUC 0.927,P < 0.001),sensitivity(33.3%)and specificity(87.2%)for a RAP cut-off value of 7.5 mm Hg(AUC 0.598,P < 0.001),sensitivity(75.1%)and specificity(48.3%)for a RAA cut-off value of 17.15 cm ~2(AUC 0.625,P < 0.001),sensitivity(88.0%)and specificity(80.9%)for a TRPG cut-off value of 44.5 mm Hg(AUC 0.910,P < 0.001).When these indicators are used to detect PAH,the cut-off value of the s PAP is increased to 63.5 mm Hg,and the sensitivity and specificity are both reduced.In addition,the cut-off value of the m PAP and TRPG are also raised.The cut-off value of the d PAP and PVR did not change,but the AUC of those five DE indicators are all lowered.And its sensitivity and specificity are also generally lowered.Three DE indicators,including PCWP,RAP and RAA,have no diagnosis value for PAH.Conclusion Our study is a prospective study that has added some new DE assessments,such as d PAP,PVR,RAP,PCWP,TRPG and RAA,important markers to evaluate PH.In this study,except for the PCWP,the remaining DE measurements mentioned above are related with respective invasive measurements by RHC.This study also conducted ROC analysis to evaluate the diagnostic value of DE and further illustrated that echocardiography is a reliable method for detecting PH. |
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