• Bryce E Montané, Andrew M Fiore, Emily C Reznicek, Vardhmaan Jain, Christine Jellis, Haala Rokadia, Manshi Li, Xiaofeng Wang, Raed Dweik, Eileen Loh, A Claire Watkins, Francois Haddad, Myriam Amsallem, Roham T Zamanian, Vinicio Jesus Perez, and Gustavo A Heresi.
• Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
• Chest. 2021 Dec 1; 160 (6): 2209-2219.

BackgroundA mean pulmonary artery pressure >20 mm Hg now defines pulmonary hypertension. We hypothesize that echocardiographic thresholds must be adjusted.Research QuestionShould tricuspid regurgitation velocity thresholds to screen for pulmonary hypertension be revised, given the new hemodynamic definition?Study Design And MethodsThis multicenter retrospective study included 1,608 patients who underwent both echocardiography and right heart catherization within 4 weeks. The discovery cohort consisted of 1,081 individuals; the validation cohort included 527. Screening criteria for pulmonary hypertension were derived with the use of receiver operating characteristic analysis and the Youden index, assuming equal cost for false-positive and -negative classification. A lower threshold was calculated with the use of a predefined sensitivity: 95%.ResultsIn the discovery cohort, echocardiographic tricuspid regurgitation velocity had a good discrimination for pulmonary hypertension: area under the curve, 88.4 (95% CI, 85.3-91.5). A 3.4-m/s threshold provided a 78% sensitivity, 87% specificity, and 6.13 positive likelihood ratio to detect pulmonary hypertension; 2.7 m/s had a 95% sensitivity and 0.12 negative likelihood ratio to exclude pulmonary hypertension. In the validation cohort, the discovery threshold of 2.7 m/s provided sensitivity and negative likelihood ratios of 80% and 0.31, respectively. Right cardiac size improved detection of pulmonary hypertension in the lower tricuspid regurgitation velocity groups.InterpretationOur data support a lower tricuspid regurgitation velocity of approximately 2.7 m/s for screening pulmonary hypertension, with a high sensitivity in tertiary referral centers. Right heart chamber measurements improve the diagnostic yield of echocardiography.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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