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. 2023 Dec 15:23:146-153.
doi: 10.1016/j.xjtc.2023.10.030. eCollection 2024 Feb.

Endobronchial ultrasound: A novel screening test for pulmonary hypertension prior to major pulmonary surgery

Nathaniel Deboever  1 , George A Eapen  2 , Roberto F Casal  2 , Jean-Bernard Durand  3 , Michael A Eisenberg  1 , Hope Feldman  1 , Celestino May  1 , Zohra Ali  1 , David C Rice  1 , Reza J Mehran  1
Affiliations

Endobronchial ultrasound: A novel screening test for pulmonary hypertension prior to major pulmonary surgery

Nathaniel Deboever et al. JTCVS Tech. .

Abstract

Objectives: Pulmonary hypertension (PH) is an important physiologic variable in the assessment of patients undergoing major thoracic operations but all too often neglected because of the need for right heart catheterization (RHC) due to the inaccuracy of transthoracic echocardiography. Patients with lung cancer often require endobronchial ultrasound (EBUS) as part of the staging of the cancer. We sought to investigate whether EBUS can be used to screen these patients for PH.

Methods: Patients undergoing a major thoracic operation requiring EBUS for staging were included prospectively in the study. All patients had also a RHC (gold standard). We aimed to compare the pulmonary artery pressure measurements by EBUS with the RHC values.

Results: A total of 20 patients were enrolled in the study. The prevalence of abnormal pulmonary artery pressure was 65% based on RHC. All patients underwent measurement of the pulmonary vascular acceleration time (PVAT) by EBUS with no adverse events. Linear regression analysis comparing PVAT and RHC showed a correlation (r = -0.059, -0.010 to -0.018, P = .007). A receiver operator characteristic curve (area under the curve = 0.736) was used to find the optimal PVAT threshold (140 milliseconds) to predict PH; this was used to calculate a positive and negative likelihood ratio following a positive diagnosis of 2.154 and 0.538, respectively.

Conclusions: EBUS interrogation of pulmonary artery hemodynamic is safe and feasible. EBUS may be used as a screening test for PH in high-risk individuals.

Keywords: endobronchial ultrasound; high risk lung resection; preoperative screening; pulmonary hypertension.

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Conflict of interest statement

R.F.C. has received research grants from Siemens and Olympus, and he is paid consultant for Intuitive Surgical, Siemens, and Olympus. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Graphical abstract
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Endobronchial ultrasound evaluation of the pulmonary artery vascular acceleration time.
Figure 1
Figure 1
Olympus (EVIS EXERA III)-generated endobronchial ultrasound investigation of the pulmonary artery, with velocities graphically represented on an x-y axis. V1 represents a velocity of 0 cm/s, and V2 represents maximal velocity. AcT represents the acceleration time taken between V1 and V2.
Figure 2
Figure 2
Linear regression model with 95% confidence intervals, comparing endobronchial ultrasound–generated pulmonary vascular acceleration time (EBUS PVAT) with right heart catheterization–generated median pulmonary artery pressure (RHC mPAP).
Figure 3
Figure 3
Limits of agreement between right heart catheterization (RHC)-generated mean pulmonary artery pressure (mPAPRHC) and calculated mean pulmonary artery pressure from endobronchial ultrasound (EBUS)-generated pulmonary vascular acceleration time (mPAPEBUS) originating from the Bland–Altman analysis (solid line: median = 0.000, dotted lines: 95% confidence interval).
Figure 4
Figure 4
Fagan nomogram with pulmonary vascular acceleration time threshold set at 140 milliseconds revealing a positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of 2.154 and 0.538, respectively, in our sample of patients with a pulmonary hypertension prevalence of 65% (prior prob). The positive probability (blue line) and negative probability (red line) are 80% and 50%, respectively.
Figure E1
Figure E1
Receiver operator curve, with 2 × 2 table representing the results of RHC (threshold of 20 mm Hg), as well as EBUS (threshold of 140 milliseconds). RHC, Right heart catheterization; EBUS, endobronchial ultrasound.
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