The additive value of echocardiographic pulmonary to left atrial global strain ratio in the diagnosis of pulmonary hypertension

Background: The distinction between pre-capillary and post-capillary pulmonary hypertension (PH) is central to accurate diagnosis and appropriate therapy. We aimed to investigate the ability of the novel echocardiographic pulmonary to left atrial global strain ratio (ePLAGS) to distinguish pre-capillary frompost-capillary PH and compare its discriminatory strength with the echocardiographic pulmonary to left atrial ratio (ePLAR). Methods: Consecutive subjectswith unexplained dyspnea or heart failure underwent echocardiography immediately followed by right heart catheterization. Subjects who did not satisfy the ESC/ERS criteria for PH, in atrial fibrillation or under pacemaker therapy, or with significant concomitant valvular disease were excluded. ePLAGS was calculated as peak tricuspid regurgitation velocity divided by left atrial global reservoir strain. Results: One hundred and thirty PHsubjects, as defined by right heart catheterization, were included in the analysis (pre-capillary: n = 64, post-capillary: n = 66). ePLAGS was lower in pre-capillary compared with post-capillary PH (0.19 +/- 0.14 vs. 0.45 +/- 0.58 m/s/%; p= 0.02) and significantly different between combined post-and precapillary PH (Cpc-PH) and isolated post-capillary PH (Ipc-PH) (0.62 +/- 0.85 vs. 0.32 +/- 0.19 m/s/%; p = 0.04). ePLAR was higher in pre-capillary as compared with post-capillary PH (0.37 +/- 0.16 vs. 0.20 +/- 0.08; p < 0.001) but did not differ between Ipc-PH and Cpc-PH. ePLAGS demonstrated stronger discriminating power than ePLAR to distinguish pre-capillary frompost-capillary PH (AUC= 0.80 vs. 0.70). In the setting of post capillary PH, ePLAGS showed reasonable ability to distinguish Ipc-PH from Cpc-PH (AUC= 0.65). ePLAR, however, did not differentiate these two groups (AUC= 0.49; p > 0.05). Conclusions: ePLAGS accurately differentiates pre-capillary from post-capillary PH and demonstrates higher diagnostic ability than ePLAR. (C) 2019 Elsevier B.V. All rights reserved.