Echocardiographic Estimation of Mean Pulmonary Artery Pressure:

A Comparison Of Different Approaches to Assign the Likelihood

ofPulmonary Hypertension
Jounal of the American Society of Echocardiography, January 2018

Muchtar Nora Ismail Siregar

 Background
Pulmonary Hypertension (PH) is
defined as a mean pulmonary
artery pressure (PAPm) of ≥ 25
mmHg at rest as assessed by Right
Heart Catheterization (RHC)

Examine the accuracy of verious approaches

for estimating PAPm (incl. TR Vmax), in
retrospective analysis patients who
underwent echocardiography and RHC
 METHODS – Study Design , Population, and Definition
Retrospective
Echocardiography and RHC
Max interval 24h
Between 2011 – 2016

Compare various TR-

derived or PAT approaches
METHODS – Data Analysis and Statistical
 Correlation between estimated PAPm and
invasively PAPm Spearman Correlation
 The degree of agreement between invasively
PAPm and echocardiographic method Bland-
Altman plots
RESULTS– Echocardiographic Estimation of PAPm
Median PAPm
Median PAPm
34.9 mmHg
32.5mmHg

Median PAPm
37.3 mmHg
 RESULTS- Correlation of Different Methods with
Invasive PAPm and Bland-Altman Analysis

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 RESULTS- Correlation of Different Methods with
Invasive PAPm and Bland-Altman Analysis

Mean Value of difference between invasively measured PAPm and

noninvasively was near zero. The limits of agreement range ± 20
mmHg (Aduen et al and Chemla et al) and ±30mmHg (Debastani)
RESULTS- Performance of Different Methods for
Determining the Likelihood of PH
RESULTS- Performance of Different Methods for
Determining the Likelihood of PH
 DISCUSSION
The method recommendation in the guidelines (TR
Vmax) is inferior to all analyzed methods that invovle
eRAP, significant lower AUC and lower OR

TR Pmean + eRAP is superior to PAPsys

Direct method for estimating PAPm had greater

accuracy compared with empirical methods

PAT-derived method shows a weak correlation,

However PAT<100mslikelihood PH
Agreement between Noninvasive Estimation
of PAPm and Invasive Measurement
 Over and underestimation may eventually
occur, regardless of which echocardiographic
method is used
 Multimodal modal approach and combination
of several echo parameter to noninvasively
estimates likelihood of PH
Tracing the Continuous-Wave Doppler Envelope of
TR VS PAT-Derived
 Method of Aduen et al highest correlation
with invasively measured PAPm and highest
OR
 Method of Aduen et al cannot be applied on
insufficient or absent TR signal
 As an alternative, PAPm may also be
calculated from PAT
 PAT method correlated weakly with invasively
measured PAPm
 Maximal Tricuspid Regurgitation Velocity
 To avoid inaccuracies of eRAP, ESC guideline
reccomend the use of TR Vmax
 TR Vmax was associated with significantly
weaker correlation , lower AUC, compared TR-
derived methods for estimating PAPm
 Method of Aduen et al is superior to the
determination of TR Vmax alone
THANK YOU