INTRODUCTION
Pulmonary hypertension (PH) is common in heart failure (HF)1 and is associated with poor prognosis.2 Passive downstream elevations in left heart pressures often combined with pulmonary arteriolar remodeling are seen both in HF with preserved (HFpEF) and reduced ejection fraction (HFrEF) and carry therapeutic implications.3 PH is defined as per current recommendations as a mean pulmonary artery pressure (PAPM) ≥ 25mmHg at rest, measured during right heart catheterization (RHC).4 Although definite PH diagnosis necessitates an invasive evaluation of PAPM,Doppler echocardiography (DE) is routinely employed to screen for PH and evaluate hemodynamic severity during follow-up. Multiple approaches to estimate PAPM using DE have been previously proposed.5-11 Most algorithms incorporate elements of Doppler analysis obtained from tricuspid regurgitation (TR),5 8 9 11 pulmonary regurgitation (PR)7 or flow across the right ventricular outflow tract (RVOT)6 12 into empirical relationships to obtain PAPM. However, the accuracy of these approaches to estimate invasive PAPM in the specific setting of heart failure has not been studied. Further, current ESC recommendations do not advise use of any DE algorithms to assess PAPMbut instead recommend the use of tricuspid regurgitation peak velocity (TRVmax) cut-off >2.8m/sec to assign PH probability.4 Availability of alternative echocardiographic approaches that represent invasive PAPM could potentially replace TRVmaxduring screening, and may even obviate the need for invasive assessment. Studies directly comparing diagnostic performance of the recommended TRVmax cut-off and echocardiographic PAPM algorithms to identify PH are few.13
With this background, we aimed to study the feasibility and accuracy of 4 different DE methods to estimate PAPM in a retrospective analysis of HF subjects undergoing near-simultaneous RHC. Further, we wished to compare the diagnostic performance of these algorithms with recommendation-based TRVmax to identify PH.