The Accuracy of Determining Pulmonary Artery Pressure by PR and TR Velocities Compared With Right Heart Catheterization in Patients With Right Ventricular Dysfunction

The gold standard for the diagnosis of pulmonary arterial hypertension (PAH) is right heart catheterization (RHC). The use of noninvasive echocardiographic methods to assess the pulmonary artery pressure (PAP) has been debated, and the role of echocardiography has been proposed to be more of estimating the probability of PAH rather than assessing the pressure. In this study, we assessed the accuracy of the use of pulmonary regurgitant (PR) and tricuspid regurgitant (TR) velocities in estimating PAH by comparison with RHC in patients with right ventricular dysfunction.

This cross-sectional study was performed in Rajaie Cardiovascular Medical and Research Center from 2015 through 2016. We selected patients with right ventricular dysfunction who were candidates for RHC. Echocardiography was performed within 24 hours before catheterization. PAH was estimated by using PR and TR velocities. The correlation between echocardiography and catheterization-derived PAH was tested by using the Pearson correlation test.

There was significant accordance between the 2 tools in terms of the measurement of the systolic PAP (r =0.860, P <0.001), the diastolic PAP (r =0.793, P <0.001), and the mean PAP (r =0.739, P <0.001) in the diagnosis of PAH (Κ =0.964, P <0.001). Based on the receiver operating characteristic curve analysis, the measurement of the TR velocity had a moderate value in predicting PAH (the area under the curve =0.622). The best cutoff value for the TR velocity in predicting PAH was 3.27, yielding a sensitivity of 72.1% and a specificity of 50.0%.

Echocardiography-derived measurements were in good correlation with RHC in the assessment of PAH in our patients with right ventricular dysfunction. (Iranian Heart Journal 2021; 22(3): 81-87)