The accuracy and influencing factors of Doppler echocardiography in estimating pulmonary artery systolic pressure: comparison with right heart catheterization: a retrospective cross-sectional study

Abstract

Abstract Background Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAP ECHO ) has been widely adopted to screen for pulmonary hypertension (PH), but there is still a high proportion of overestimation or underestimation of sPAP ECHO . We therefore aimed to explore the accuracy and influencing factors of sPAP ECHO with right heart catheterization (RHC) as a reference. Methods A total of 218 highly suspected PH patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR)-related methods and RHC results were tested by Pearson and Bland–Altman methods. TR-related methods included peak velocity of TR (TR Vmax), TR pressure gradient (TR-PG), TR mean pressure gradient (TR-mPG), estimated mean pulmonary artery pressure (mPAP ECHO ), and sPAP ECHO . With mPAP ≥ 25 mm Hg measured by RHC as the standard diagnostic criterion of PH, the ROC curve was used to compare the diagnostic efficacy of sPAP ECHO with other TR-derived parameters. The ratio (sPAP ECHO –sPAP RHC )/sPAP RHC was calculated and divided into three groups as follows: patients with an estimation error between − 10% and + 10% were defined as the accurate group; patients with an estimated difference greater than + 10% were classified as the overestimated group; and patients with an estimation error greater than − 10% were classified as the underestimated group. The influencing factors of sPAP ECHO were analyzed by ordinal regression analysis. Results sPAP ECHO had the highest correlation coefficient (r = 0.781, P < 0.001), best diagnostic efficiency (AUC = 0.98), and lowest bias (mean bias = 0.07 mm Hg; 95% limits of agreement, − 32.08 to + 32.22 mm Hg) compared with other TR-related methods. Ordinal regression analysis showed that TR signal quality, sPAP RHC level, and pulmonary artery wedge pressure (PAWP) affected the accuracy of sPAP ECHO ( P < 0.05). Relative to the good signal quality, the OR values of medium and poor signal quality were 0.26 (95% CI: 0.14, 0.48) and 0.23 (95% CI: 0.07, 0.73), respectively. Compared with high sPAP RHC level, the OR values of low and medium sPAP RHC levels were 21.56 (95% CI: 9.57, 48.55) and 5.13 (95% CI: 2.55, 10.32), respectively. The OR value of PAWP was 0.94 (95% CI: 0.89, 0.99). TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAP ECHO . Conclusions In this study, we found that all TR-related methods, including sPAP ECHO , had comparable and good efficiency in PH screening. To make the assessment of sPAP ECHO more accurate, attention should be paid to TR signal quality, sPAP RHC level, and PAWP.

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