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Accuracy and Diagnostic Performance of Doppler Echocardiography to Estimate Mean Pulmonary Artery Pressure in Heart Failure
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  • Alva Bjorkman,
  • Lars H. Lund,
  • Ulrika Faxen,
  • Per Lindqvist,
  • Ashwin Venkateshvaran
Alva Bjorkman
Karolinska Institute

Corresponding Author:[email protected]

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Lars H. Lund
Karolinska Univ Hosp
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Ulrika Faxen
Karolinska Institute
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Per Lindqvist
Umeå University Hospital
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Ashwin Venkateshvaran
Karolinska Institute
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BACKGROUND. Multiple Doppler Echocardiography (DE) algorithms have been proposed to estimate mean pulmonary artery pressure (PAPM) and assess pulmonary hypertension (PH) likelihood. We assessed the accuracy of 4 different DE approaches to estimate PAPM in patients with heart failure (HF) undergoing near-simultaneous right heart catheterization (RHC), and compared their diagnostic performance to identify PH with recommendation-advised tricuspid regurgitation peak velocity (TRVmax). METHODS. PAPM was retrospectively assessed in 112 HF patients employing 4 previously validated DE algorithms. Association and agreement with invasive PAPM were assessed. Diagnostic performance of DE methods vs. TRVmax=2.8m/sec to identify invasive PAPM ≥ 25mmHg were compared. RESULTS. All DE algorithms demonstrated reasonable association (r = 0.41 to 0.65; p<0.001) and good agreement with invasive PAPM, with relatively lower mean bias and higher precision observed in algorithms that included TRVmax or velocity time integral. All methods demonstrated strong ability (AUC=0.70-0.80; p<0.001) to identify PH but did not outperform TRVmax (AUC=0.84; p<0.001). Echocardiographic estimates of right atrial pressure were considered in 3 of 4 DE algorithms and falsely elevated in as many as 30% of patients. CONCLUSIONS. Echocardiographic estimates of PAPM demonstrate reasonable accuracy to represent invasive PAPM and strong ability to identify PH in HF. However, even the best performing algorithm did not outperform recommendation-advised TRVmax. The additional value of echocardiographic estimates of right atrial pressure may need to be re-evaluated.
08 Jun 2021Submitted to Echocardiography
09 Jun 2021Submission Checks Completed
09 Jun 2021Assigned to Editor
11 Jun 2021Reviewer(s) Assigned
26 Jun 2021Review(s) Completed, Editorial Evaluation Pending
30 Jun 2021Editorial Decision: Revise Major
01 Jul 20211st Revision Received
01 Jul 2021Assigned to Editor
01 Jul 2021Submission Checks Completed
09 Jul 2021Reviewer(s) Assigned
20 Jul 2021Review(s) Completed, Editorial Evaluation Pending
23 Jul 2021Editorial Decision: Revise Minor
26 Jul 20212nd Revision Received
27 Jul 2021Submission Checks Completed
27 Jul 2021Assigned to Editor
01 Aug 2021Reviewer(s) Assigned
12 Aug 2021Review(s) Completed, Editorial Evaluation Pending
15 Aug 2021Editorial Decision: Accept
Sep 2021Published in Echocardiography volume 38 issue 9 on pages 1624-1631. 10.1111/echo.15188