Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;8(2):1216-1229.
doi: 10.1002/ehf2.13183. Epub 2021 Feb 10.

A novel echocardiographic method for estimation of pulmonary artery wedge pressure and pulmonary vascular resistance

Vladislav Chubuchny  1 , Nicola Riccardo Pugliese  2 , Claudia Taddei  1 , Elisa Poggianti  1 , Valentina Spini  1 , Andrea Barison  1   3 , Bruno Formichi  1   4 , Edoardo Airò  1 , Carolina Bauleo  1 , Renato Prediletto  1   4 , Luigi Emilio Pastormerlo  1 , Michele Coceani  1 , Marco Ciardetti  1 , Christina Petersen  1 , Emilio Pasanisi  1 , Carlo Lombardi  5 , Michele Emdin  1   3 , Alberto Giannoni  1   3
Affiliations

A novel echocardiographic method for estimation of pulmonary artery wedge pressure and pulmonary vascular resistance

Vladislav Chubuchny et al. ESC Heart Fail. 2021 Apr.

Abstract

Aims: This study aimed to evaluate a novel echocardiographic algorithm for quantitative estimation of pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR) in patients with heart failure and pulmonary hypertension (PH) scheduled to right heart catheterization (RHC).

Methods and results: In this monocentric study, 795 consecutive patients (427 men; age 68.4 ± 12.1 years) undergoing echocardiography and RHC were evaluated. Multiple regression analysis was performed to identify echocardiographic predictors of PAWP and PVR measured by RHC in the derivation group (the first 200 patients). The diagnostic accuracy of the model was then tested in the validation group (the remaining 595 patients). PH was confirmed by RHC in 507 (63.8%) patients, with 192 (24.2%) cases of precapillary PH, 248 (31.2%) of postcapillary PH, and 67 (8.4%) of combined PH. At regression analysis, tricuspid regurgitation maximal velocity, mitral E/e' ratio, left ventricular ejection fraction, right ventricular fractional area change, inferior vena cava diameter, and left atrial volume index were included in the model (R = 0.8, P < 0.001). The model showed a high diagnostic accuracy in estimating elevated PAWP (area under the receiver operating characteristic curve = 0.97, 92% sensitivity, and 93% specificity, P < 0.001) and PVR (area under the receiver operating characteristic curve = 0.96, 89% sensitivity, and 92% specificity, P < 0.001), outperforming 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations (P < 0.001) and Abbas' equation (P < 0.001). Bland-Altman analysis showed satisfactory limits of agreement between echocardiography and RHC for PAWP (bias 0.7, 95% confidence interval -7.3 to 8.7) and PVR (bias -0.1, 95% confidence interval -2.2 to 1.9 Wood units), without indeterminate cases.

Conclusions: A novel quantitative echocardiographic approach for the estimation of PAWP and PVR has high diagnostic accuracy in patients with heart failure and PH.

Keywords: Echocardiography; Pulmonary artery wedge pressure; Pulmonary hypertension; Pulmonary vascular resistance; Right heart catheterization.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Non‐invasive estimation of pulmonary artery wedge pressure (PAWP) and pulmonary vascular resistance (PVR): equations and diagnostic accuracy of the model. (A) Distribution of the general population according to the clinical (left) and haemodynamic (right) classification. (B) Equations for echo‐derived estimation of PAWP and PVR. Echo‐parameters used for predicting PAWP and PVR: tricuspid regurgitation velocity (TRV),left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), left atrial volume index (LAVi), mitral E/e′, inferior vena cava (IVC) diameter, mean pulmonary artery pressure (PAPm) and cardiac output (CO). (C) Regression analysis showing the strong relationship of the echo‐derived estimation of PAWP (on the left) and PVR (on the right) with the right heart catheterization (RHC) measures in the validation cohort. (D) Receiver operating characteristic (ROC) curve analysis of echo‐derived PAWP as a predictor of PAWP > 15 mmHg at RHC (on the left) and echo‐derived PVR as a predictor of PVR > 3 Wood units (WU) at RHC (on the right) in the validation cohort. AUC, area under the receiver operating characteristic curve; CTEPH, chronic thromboembolic pulmonary hypertension; LAA, left atrial area; LHD, left heart disease; PAH, pulmonary arterial hypertension; PH, pulmonary hypertension.
Figure 2
Figure 2
Agreement between pulmonary artery wedge pressure measured at right heart catheterization (PAWPcath) and echo‐derived pulmonary artery wedge pressure (PAWPecho) in the validation group. Bland–Altman plots comparing PAWPecho with PAWPcath in patients without and with pulmonary hypertension (PH), as well as in different subgroups of PH according to the clinical classification. SD, standard deviation.
Figure 3
Figure 3
Agreement between pulmonary vascular resistance measured at right heart catheterization (PVRcath) and echo‐derived pulmonary vascular resistance (PVRecho) in the validation group. Bland–Altman plots comparing PVRecho with PVRcath in patients without and with pulmonary hypertension (PH), as well as in different subgroups of PH according to the clinical classification.
See this image and copyright information in PMC

References

    1. Galiè N, Humbert M, Vachiéry J‐L, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Noordegraaf AV, Beghetti M, Ghofrani A, Sanchez MAG, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, ESC Scientific Document Group . 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2016; 37: 67–119. - PubMed
    1. Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, Williams PG, Souza R. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019; 53: 1801913. - PMC - PubMed
    1. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C, Ghofrani A, Gomez Sanchez MA, Krishna Kumar R, Landzberg M, Machado RF, Olschewski H, Robbins IM, Souza R. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 2013; 62: D34–D41. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola V‐P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force Members . 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37: 2129–2200. - PubMed
    1. Abbas AE, Franey LM, Marwick T, Maeder MT, Kaye DM, Vlahos AP, Serra W, al‐Azizi K, Schiller NB, Lester SJ. Noninvasive assessment of pulmonary vascular resistance by Doppler echocardiography. J Am Soc Echocardiogr 2013; 26: 1170–1177. - PubMed

LinkOut - more resources