Echocardiographic probability of pulmonary hypertension: a real world audit comparing 2015 and 2022 ESC guidelines

Abstract Introduction Transthoracic echocardiography (TTE) is an established screening tool used in the assessment of suspected Pulmonary Hypertension (PH). ESC guidelines released in 2015 recommend the use of specific echocardiographic parameters for the assessment of PH. Here, the tricuspid regurgitation velocity (TRV) together with echocardiographic markers of PH from three categories (the ventricles, the pulmonary artery, and the IVC/RA) are used to define the echocardiographic probability of PH being present (as either, low, intermediate or high). In 2022, the ESC updated this algorithm to include a revised haemodynamic definition of PH and also additional parameters for estimating the echocardiographic probability of PH(1). New parameters include the TAPSE/sPAP ratio as well as the combined assessment of the pulmonary artery (PA) and aortic root diameter. This retrospective audit evaluates the impact of the most recent 2022 ESC TTE PH algorithm in detecting PH in a real world cohort referred to a shared care PH centre. Method Between 2010 and 2020, a total of 306 patients referred for initial assessment of PH underwent TTE followed by RHC (mean interval 31±29 days). PH TTE probabilities were calculated using both 2015 and 2022 ESC guidance. The 2022 haemodynamic definition of PH was applied to both cohorts. The sensitivity and specificity of both 2015 and 2022 were calculated. Results The mean sample age is 67±14years (62% female). A summary of the TTE PH probability parameters is shown in Table 1. Using the 2015 ESC algorithm, the cohort comprised 24% (n=75), 23% (n=70) and 53% (161) for low, intermediate, and high TTE PH probability respectively. Within the low TTE probability group, 33% (n=25) had PH confirmed at RHC (see Figure 1). Sensitivity and specificity for the cohort is 88% and 65% respectively. The same dataset analysed using the 2022 algorithm demonstrates that 23% (n=71) has a low TTE PH probability, 19% (n=58) intermediate and 58% (n=177) a high TTE PH probability. Within the low TTE group the percentage of patients with PH at RHC was 35% (n=25) (Figure 1). Sensitivity and specificity for the 2022 TTE PH probability algorithm was 89% and 62% respectively. The introduction of the TAPSE/sPAP ratio (<0.55 mm/mmHg) contributed to 16 patients changing from intermediate to high TTE PH probability. Two patients with a low TTE probability demonstrated a ratio <0.55 mm/mmHg, of which one moved from low to intermediate probability. The PA/AR diameter led to 3 patients changing from low to intermediate TTE PH probability. Conclusion The sensitivity and specificity for the 2015 and new 2022 PH TTE probability algorithm are similar. Further developments in TTE algorithms are needed to improve the detection of PH in those thought to have a low TTE probability of PH.Table 1.0Figure 1.0