Qualitative echocardiography parameters for prediction of pulmonary hypertension

Summary Background:  Current guidelines recommend echocardiography as the preferred screening method for pulmonary hypertension (PH). The probability of PH is primarily assessed by estimating the right ventricular systolic pressure while the value of qualitative parameters is uncertain. The aim of our study was to evaluate the diagnostic yield of qualitative and quantitative parameters from routine echocardiography reports for PH diagnosis.  Methods:  Consecutive patients with suspected PH who received right heart catheterisation and echocardiography within 2 weeks between April 2003 and September 2008 were retrospectively included. PH was diagnosed by a mean pulmonary artery pressure of ≥ 25 mmHg on right heart catheterisation. Qualitative and quantitative parameters from echocardiography reports were analysed with respect to their predictive value for PH diagnosis.  Results:  Inclusion criteria were met by 272 patients. Diagnosis of PH was confirmed in 172 and excluded in 100 patients. Qualitative and quantitative information about the right ventricle was available in 93% and 85% of the echocardiography reports respectively. Qualitative descriptions of the right ventricle to be dilated predicted PH with sensitivity, specificity, negative and positive predictive value of 89%, 63%, 78% and 80% respectively. An estimated right ventricular systolic pressure of ≥ 50 mmHg on echocardiography predicted PH with sensitivity, specificity, negative and positive predictive value of 84%, 69%, 68% and 84% respectively.  Conclusion:  Qualitative parameters are frequently described in routine echocardiography reports and are valuable for the prediction of PH with a similar diagnostic accuracy as the estimation of right ventricular systolic pressure.