Doppler echocardiography (DE) is an important diagnostic test in the assessment of patients with pulmonary hypertension (PH). Stereotypical 2-D/Doppler features of increased left atrial pressure or pulmonary venous hypertension (PVH) and PH associated with pulmonary vascular disease (PVD), i.e. PAH, have been described. We integrated selected 2D and Doppler findings from a standard DE via scoring algorithm to determine if this provides insight into the pathophysiology of PH in a mixed cohort.
76 consecutive patients referred to our PH center underwent standard DE and then right heart catheterization. The DE was scored on the basis of 2D/Doppler evidence suggesting PVH (LVH, left atrial enlargement, pseudonormal/restrictve transmitral Doppler; yes=0, no=1) or suggesting PVD (septal bowing, RV:LV ratio≥1, TAPSE<2; yes=1, no=0) and Doppler ‘notching’ in RV outflow tract; yes=2, no=0). A low score should suggest PVH only; a high score PVD only, and an intermediate score a mix of both PVH and PVD. The echo score ranged from 0–8. Patients were divided into three groups based on echo scores (groups I; 0–2, II; 3–5, III; 6–8) and hemodynamics compared. *P<0.05 groups I vs. III, # groups I vs. II, † groups II vs. III.
Table 1 summarizes the data. Group I subjects were older, had less severe PH, a much lower PVR and a normal CI vs. groups II and III. Group II had increased PVR and increased PCWP whereas group III had a high PVR and a normal PCWP. 56 of 58 subjects with an echo score of ≥3 had PVR>3; all subjects with a score ≥6 had a PVR ≥4.5 WU. Only 1 of 24 subjects with score <3 had PAH; no subjects with a score ≥6 had PVH.
This preliminary work suggests that a simple DE scoring system provides pathophysiologic insight along a hemodynamic spectrum in a mixed PH cohort.
A simple echo scoring system may allow rapid identification and triage of PH patients with pulmonary vascular disease for invasive diagnostic testing.
Vikram Prasanna, No Financial Disclosure Information; No Product/Research Disclosure Information