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Reliability of echocardiographic estimation of pulmonary artery pressure in patients with severe tricuspid regurgitation


 
 
 Transthoracic Echocardiography (TTE) seems to be mistaken for the estimation of systolic Pulmonary Artery Pressure (sPAP) especially in patients with severe Tricuspid Regurgitation (TR). This study aimed to determine the reliability of the assessment of sPAP by TTE in this population.
 
 
 
 This is a monocentric analysis of 236 consecutive patients with concomitant Right Heart Catheterization (RHC) and TTE performed in the assessment of an heart failure syndrome. Lin's Concordance Coefficient (LCC) and Bland-Altman Analysis (BAA) were used to compare the values of RHC and TTE.
 
 
 
 The correlation between the two procedures was good in the total population (LCC = 0.80; 95% limits of agreement (LOA): 0.74; 0.84), but weaker in the 78 patients (33%) with severe TR (LCC = 0.67; 95% LOA: 0.49; 0.80), with a propensity to an underestimation by TTE. Altered Right Ventricular (RV) – Pulmonary Artery (AP) coupling did not lead to a misestimation, contrary to an elevated Right Atrial Pressure (RAP), which was associated with an underestimation by TTE of about 8 mmHg. The presence of “C-V waves” sign on the RAP curves (Odds-Ratio (OR) = 3.32; 95% Confidence Interval (CI): 1.02; 10.9; p=0.04) and invasive sPAP ≥50 mmHg (OR = 2.63; 95% CI: 1.35; 5.16; p<0.01) were two independent predictors of a misestimation of sPAP by TTE.
 
 
 
 Severe TR led to an underestimation by TTE, especially if the RAP curve shows a “C-V waves” sign, and in the case of high invasive sPAP.
 
 
 
 Type of funding sources: Public hospital(s). Main funding source(s): CHU Rennes Pontchaillou
