State-of-the-Art Review: Echocardiography in Pulmonary Hypertension

Cordina, Rachael; Playford, David; Lang, Irene M.; Celermajer, David S.

doi:10.1016/j.hlc.2019.03.003

Cited by 33 publications

(35 citation statements)

References 53 publications

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“…A paradigm shift is occurring in the assessment of the RV from a simple, qualitative visual assessment on echocardiography to a more sophisticated routine quantification of parameters of RV structure and function, despite technical difficulties related to its complex, roughly triangular shape that wraps around the left ventricle [12,13]. As one of many examples of clinical utility, dimensions of the right ventricular outflow tract (RVOT) may be used as part of the revised diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy [14].…”

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confidence: 99%

“…Jones et al explain the available parameters and recommend the routine measurement of more than two, including structural RV basal and RVOT proximal dimensions, and functional fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). TAPSE measures right ventricular longitudinal shortening and is a surrogate of systolic function [13]. With further technical development in 3D and strain imaging, more assessment may become routine [12,13].…”

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confidence: 99%

“…TAPSE measures right ventricular longitudinal shortening and is a surrogate of systolic function [13]. With further technical development in 3D and strain imaging, more assessment may become routine [12,13].…”

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confidence: 99%

“…Echocardiographic techniques can also be employed to estimate pulmonary artery pressure and resistance, and right atrial pressure, and to derive indirect information about right heart structure and function, as stated in Cordina and colleagues' review [13]. This allows echocardiography to play an essential role as a screening tool for pulmonary hypertension, although cardiac catheterisation is still required for a formal diagnosis.…”

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confidence: 99%

“…Cordina and colleagues discuss the use of additional echocardiographic tools in the setting of pulmonary hypertension including transoesophageal echocardiography (e.g., when a congenital shunt is suspected) and the use of agitated saline administered via a peripheral vein (i.e., a bubble test) to assess the degree of right to left shunting in patients who have hypoxaemia out of proportion to the degree of lung parenchymal or pulmonary vascular disease. They also discuss the currently controversial role for exercise and dobutamine stress echocardiography in the diagnosis of pulmonary hypertension [13].…”

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confidence: 99%

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Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

Gregory

Stanton

Thomas

et al. 2019

Heart, Lung and Circulation

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Echocardiography has been around for more than half a century [1]. Recent decades have seen significant technological advances, with increasing clinical applications of this non-invasive imaging tool, beyond the basic assessment of left ventricular function, with further evolution evident on the horizon. There has also been a burgeoning increase in use: According to the 2017 Australian Medicare Medical Benefits Schedule (MBS) Taskforce, about 900,000 echocardiographic procedures (excluding stress echo) are reimbursed annually, at a cost of over $180 million each year [2]. In addition, the use of echo is growing at a rate of about 8.8% each year [3]. Stress echocardiography accounts for over $56 million in billing annually in Australia and has grown each year at a rate of 12% for the past 5 years [4]. In recognition of this expanding use, this fully commissioned Special Issue of Heart, Lung and Circulation presents an overview of contemporary practice in echocardiography.

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Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

Gregory

Stanton

Thomas

et al. 2019

Heart, Lung and Circulation

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The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients

et al. 2023

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There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross‐sectional, community‐based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6‐min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years ( SD 13.8 years) and a median of one TB episode (interquartile range: 1–2). Co‐morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35–40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH‐postTB 2.13‐fold (confidence interval [CI]: 1.17–3.88; p = 0.013). All of those found to have PH were smokers or ex‐smokers yielding an unadjusted odds ratio for PH‐postTB of 3.67 (95% CI: 0.77–17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co‐morbidities demonstrated significant association with PH. PH after TB was a common finding in this community‐based population. Further research is needed to confirm and determine the significance of these findings.

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Automatic echocardiographic evaluation of the probability of pulmonary hypertension using machine learning

et al. 2023

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Echocardiography, a simple and noninvasive tool, is the first choice for screening pulmonary hypertension (PH). However, accurate assessment of PH, incorporating both the pulmonary artery pressures and additional signs for PH remained unsatisfied. Thus, this study aimed to develop a machine learning (ML) model that can automatically evaluate the probability of PH. This cohort included data from 346 (275 for training set and internal validation set and 71 for external validation set) patients with suspected PH patients and receiving right heart catheterization. Echocardiographic images on parasternal short axis‐papillary muscle level (PSAX‐PML) view from all patients were collected, labeled, and preprocessed. Local features from each image were extracted and subsequently integrated to build a ML model. By adjusting the parameters of the model, the model with the best prediction effect is finally constructed. We used receiver‐operating characteristic analysis to evaluate model performance and compared the ML model with the traditional methods. The accuracy of the ML model for diagnosis of PH was significantly higher than the traditional method (0.945 vs. 0.892, p = 0.027 [area under the curve [AUC]]). Similar findings were observed in subgroup analysis and validated in the external validation set (AUC = 0.950 [95% CI: 0.897−1.000]). In summary, ML methods could automatically extract features from traditional PSAX‐PML view and automatically assess the probability of PH, which were found to outperform traditional echocardiographic assessments.

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State-of-the-Art Review: Echocardiography in Pulmonary Hypertension

Cited by 33 publications

References 53 publications

Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

Echocardiography: Navigating Complexities to Provide Many Useful Applications in Contemporary Clinical Cardiology

The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients

Automatic echocardiographic evaluation of the probability of pulmonary hypertension using machine learning

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