A stepwise composite echocardiographic score predicts severe pulmonary hypertension in patients with interstitial lung disease

ERJ Open Research
Simon BaxLaura Price

Abstract

European Respiratory Society (ERS) guidelines recommend the assessment of patients with interstitial lung disease (ILD) and severe pulmonary hypertension (PH), as defined by a mean pulmonary artery pressure (mPAP) ≥35 mmHg at right heart catheterisation (RHC). We developed and validated a stepwise echocardiographic score to detect severe PH using the tricuspid regurgitant velocity and right atrial pressure (right ventricular systolic pressure (RVSP)) and additional echocardiographic signs. Consecutive ILD patients with suspected PH underwent RHC between 2005 and 2015. Receiver operating curve analysis tested the ability of components of the score to predict mPAP ≥35 mmHg, and a score devised using a stepwise approach. The score was tested in a contemporaneous validation cohort. The score used "additional PH signs" where RVSP was unavailable, using a bootstrapping technique. Within the derivation cohort (n=210), a score ≥7 predicted severe PH with 89% sensitivity, 71% specificity, positive predictive value 68% and negative predictive value 90%, with similar performance in the validation cohort (n=61) (area under the curve (AUC) 84.8% versus 83.1%, p=0.8). Although RVSP could be estimated in 92% of studies, reducing this to 60% m...Continue Reading

References

Dec 14, 2002·American Journal of Respiratory and Critical Care Medicine·Selim M ArcasoyRobert M Kotloff
Aug 2, 2005·The European Respiratory Journal·M R MillerUNKNOWN ATS/ERS Task Force
Sep 7, 2005·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·T P M WhelanP S Dahlberg
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Oct 21, 2005·Chest·Hassan F NadrousJay H Ryu
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Jun 30, 2009·Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography·Pamela S DouglasUNKNOWN American College of Cardiology Foundation
Jul 23, 2016·Cardiology Clinics·Ronald J Oudiz
Aug 6, 2016·Respiratory Medicine·Laith AlkukhunAdriano R Tonelli
Jan 26, 2017·The International Journal of Cardiovascular Imaging·Myriam AmsallemFrançois Haddad

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Citations

Jun 20, 2019·Expert Review of Respiratory Medicine·George A MargaritopoulosAthol U Wells
Feb 6, 2021·Clinics in Chest Medicine·Andrea M Shioleno, Nicole F Ruopp
Jun 16, 2021·Current Opinion in Pulmonary Medicine·Chinthaka B SamaranayakeLaura C Price

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