Doppler estimates of pulmonary vascular resistance to phenotype pulmonary hypertension in heart failure

Ashwin Venkateshvaran, Jasmin Hamade, Barbro Kjellström, Lars H Lund, Aristomenis Manouras, Ashwin Venkateshvaran, Jasmin Hamade, Barbro Kjellström, Lars H Lund, Aristomenis Manouras

Abstract

An accurate distinction between isolated post-capillary pulmonary hypertension (Ipc-PH) and combined post- and pre-capillary pulmonary hypertension (Cpc-PH) is integral to therapy and prognosis in heart failure (HF). This study aimed to compare the ability of four previously validated Doppler estimates of pulmonary vascular resistance (PVRDoppler) to distinguish Ipc-PH from Cpc-PH in a well-defined HF population. Consecutive subjects referred for HF assessment underwent standard echocardiography immediately followed by right heart catheterization (RHC). Subjects with atrial fibrillation, acute coronary syndrome, significant valvular disease or poor image quality were excluded. PVRDoppler estimates were correlated with invasive PVR and agreement was studied using Bland-Altman analysis. Receiver operating characteristics analyses were performed to determine the ability of PVRDoppler methods to identify PVR > 3WU. 55 HF subjects (58 ± 16 years, 55% Ipc-PH) were analyzed. PVRDoppler estimates demonstrated weak to modest associations with invasive PVR. The Doppler method proposed by Abbas et al. demonstrated relatively strong discriminatory ability to distinguish Ipc-PH from Cpc-PH (AUC = 0.79; 95% CI 0.63-0.96; p = 0.001). However, Bland-Altman analysis revealed wide limits of agreement (bias = 0; SD = 1.83WU) and greater variability at higher mean PVR. Conclusions: PVRDoppler estimates demonstrate reasonable ability to distinguish Ipc-PH from Cpc-PH but may not be reliable independent PH distinguishers in HF.

Keywords: Doppler echocardiography; Heart failure; Post-capillary pulmonary hypertension.

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Patient flow chart
Fig. 2
Fig. 2
Diagnostic accuracy of Doppler-derived PVR as per method proposed by Abbas et al. a Receiver-operating characteristic curve. A TRVmax2/TVIRVOT cut-off value of 0.59 provided best balanced sensitivity (81%) and specificity (65%) to determine PVR > 3WU. b Bland–Altman analysis of PVR obtained by Doppler and invasive PVR. c Percentage difference between Doppler-derived and invasive PVR plotted against invasive PVR

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