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IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE
BACKGROUND: 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. Intern...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580132/ https://www.ncbi.nlm.nih.gov/pubmed/36258244 http://dx.doi.org/10.1186/s44156-022-00010-9 |
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author | 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 |
author_facet | 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 |
author_sort | Slegg, Oliver Graham |
collection | PubMed |
description | BACKGROUND: 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. STUDY AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s44156-022-00010-9. |
format | Online Article Text |
id | pubmed-9580132 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-95801322022-10-20 IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE 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 Echo Res Pract Research BACKGROUND: 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. STUDY AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s44156-022-00010-9. BioMed Central 2022-10-19 /pmc/articles/PMC9580132/ /pubmed/36258244 http://dx.doi.org/10.1186/s44156-022-00010-9 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research 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 IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title | IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title_full | IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title_fullStr | IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title_full_unstemmed | IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title_short | IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE |
title_sort | improving pulmonary hypertension screening by echocardiography: impulse |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580132/ https://www.ncbi.nlm.nih.gov/pubmed/36258244 http://dx.doi.org/10.1186/s44156-022-00010-9 |
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