期刊
CHEST
卷 160, 期 6, 页码 2209-2219出版社
ELSEVIER
DOI: 10.1016/j.chest.2021.06.046
关键词
echocardiography; pulmonary hypertension; tricuspid regurgitation velocity
资金
- United Therapeutics
- Actelion
The study found that lowering the threshold of tricuspid regurgitation velocity to approximately 2.7 m/s can effectively screen for pulmonary hypertension with high sensitivity in tertiary referral centers. Right heart chamber measurements were also found to improve the diagnostic yield of echocardiography.
BACKGROUND: A mean pulmonary artery pressure >20 mm Hg now defines pulmonary hypertension. We hypothesize that echocardiographic thresholds must be adjusted. RESEARCH QUESTION: Should tricuspid regurgitation velocity thresholds to screen for pulmonary hypertension be revised, given the new hemodynamic definition? STUDY DESIGN AND METHODS: This multicenter retrospective study included 1,608 patients who underwent both echocardiography and right heart catherization within 4 weeks. The discovery cohort consisted of 1,081 individuals; the validation cohort included 527. Screening criteria for pulmonary hypertension were derived with the use of receiver operating characteristic analysis and the Youden index, assuming equal cost for false-positive and-negative classification. A lower threshold was calculated with the use of a predefined sensitivity: 95%. RESULTS: In the discovery cohort, echocardiographic tricuspid regurgitation velocity had a good discrimination for pulmonary hypertension: area under the curve, 88.4 (95% CI, 85.3-91.5). A 3.4m/s threshold provided a 78% sensitivity, 87% specificity, and 6.13 positive likelihood ratio to detect pulmonary hypertension; 2.7 m/s had a 95% sensitivity and 0.12 negative likelihood ratio to exclude pulmonary hypertension. In the validation cohort, the discovery threshold of 2.7 m/s provided sensitivity and negative likelihood ratios of 80% and 0.31, respectively. Right cardiac size improved detection of pulmonary hypertension in the lower tricuspid regurgitation velocity groups. INTERPRETATION: Our data support a lower tricuspid regurgitation velocity of approximately 2.7 m/s for screening pulmonary hypertension, with a high sensitivity in tertiary referral centers. Right heart chamber measurements improve the diagnostic yield of echocardiography.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据