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. 2018 Sep;5(3):G11-G24.
doi: 10.1530/ERP-17-0071.

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Daniel X Augustine  1 , Lindsay D Coates-Bradshaw  2 , James Willis  1 , Allan Harkness  3 , Liam Ring  4 , Julia Grapsa  5 , Gerry Coghlan  6 , Nikki Kaye  7 , David Oxborough  8 , Shaun Robinson  9 , Julie Sandoval  10 , Bushra S Rana  11 , Anjana Siva  12 , Petros Nihoyannopoulos  13 , Luke S Howard  14 , Kevin Fox  15 , Sanjeev Bhattacharyya  16 , Vishal Sharma  17 , Richard P Steeds  18 , Thomas Mathew  2
Affiliations

Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography

Daniel X Augustine et al. Echo Res Pract. 2018 Sep.

Abstract

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.

Keywords: echocardiography; guideline; pulmonary hypertension.

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Figures

Figure 1
Figure 1
Flow chart to assess the probability of pulmonary hypertension using parameters identified from within ≥2 categories (the ventricles, pulmonary artery or the inferior vena cava and right atrium) in conjunction with tricuspid regurgitation velocity. Adapted from ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension 2015 (2).
Figure 2
Figure 2
Measurement of pulmonary regurgitant jet at end diastole (marked X).
Figure 3
Figure 3
TR jet obtained at baseline (top) is improved following injection of intravenous agitated saline (bottom).
See this image and copyright information in PMC

References

    1. Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D, et al A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2015. 2 G9–G24. (10.1530/ERP-14-0079) - DOI - PMC - PubMed
    1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, et al 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). European Heart Journal 2016. 37 67–119. (10.1093/eurheartj/ehv317) - DOI - PubMed
    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Lung B, Lancellotti P, Lansac E, Munoz DR, et al 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2017. 38 2739–2791. (10.1093/eurheartj/ehx391) - DOI - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, et al 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017. 70 252–289. (10.1016/j.jacc.2017.03.011) - DOI - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, et al 2014 AHA/ACC Guideline for the management of patients with valvular heart disease. Circulation 2014. 129 e650 (10.1161/CIR.0000000000000029) - DOI - PubMed