Virtual Echocardiography as a Potential Screening Tool for the Diagnosis of Primary Pulmonary Hypertension
Primary pulmonary hypertension disease is associated with a poor prognosis. Early diagnosis and the implementation of specific therapy are necessary to improve patients' prospects. In the near future, virtual echocardiography, which has shown good results in published studies, may become a valuable screening tool.
Introduction
Pulmonary arterial hypertension (PAH) is classified by etiology into primary and secondary types. Primary pulmonary hypertension (Type I according to WHO classification) is characterized by the involvement of small arteries and is associated with a poor prognosis, necessitating early diagnosis and the initiation of specific therapy to improve patient outcomes. The gold standard in diagnosis is the catheterization of the right heart chambers, which allows differentiation between the primary form of the disease and the more common secondary form. However, during the COVID-19 pandemic, specialized examinations became less accessible.
Recent research results suggest that a valuable diagnostic tool for primary pulmonary hypertension could be virtual echocardiography, which has already shown good results in previous studies in diagnosing pulmonary hypertension.
Virtual Echocardiography in Diagnosing Primary PAH
The virtual screening tool is based on a simple analysis of several parameters obtained through routine echocardiography. The parameters required for the analysis include left atrial size, E/e' ratio, and systolic flattening of the interventricular septum. Based on the presence or absence of specific parameters, +1 or −1 point is awarded, resulting in a score ranging from −3 to +3. As the score increases, so does the likelihood of primary pulmonary hypertension.
Vaidya et al. published a study focusing on distinguishing primary pulmonary hypertension from secondary forms using virtual echocardiography, comparing this method with measuring systolic pressure in the pulmonary arteries using Doppler examination. The definitive diagnosis in the study was established through right heart catheterization, with a median of 27.5 days from the screening examination.
The study included a total of 96 patients, of whom 55 were diagnosed with primary pulmonary hypertension. Virtual echocardiography demonstrated superiority over Doppler examination in identifying patients with primary pulmonary hypertension. The sensitivity for diagnosing primary pulmonary hypertension was established at 80% and specificity at 75.6%, with an area under the curve of 0.81 (the discriminatory ability of the Doppler examination was lower, with an area under the curve of 0.56). The method's discriminatory ability remained unchanged when applied to a secondary cohort from another tertiary center.
Conclusion
Virtual echocardiography could become a valuable screening method for diagnosing primary pulmonary hypertension. Currently, during the COVID-19 pandemic, it can be an important tool for detecting patients with primary pulmonary hypertension when specialized examinations, such as right heart catheterization, are unavailable.
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Source: Vaidya A., Golbus J. R., Vedage N. A. Virtual echocardiography screening tool to differentiate hemodynamic profiles in pulmonary hypertension. Pulm Circ 2020 Sep 17; 10 (3): 2045894020950225, doi: 10.1177/2045894020950225.
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