BACKGROUND Current guidelines advise using echocardiography for noninvasive estimation of the likelihood that a patient has pulmonary hypertension (PH). To estimate the echocardiographic probability of PH, the maximal tricuspid regurgitation velocity (TR Vmax) is recommended as the main parameter to use over more complex algorithms that provide an estimation of pulmonary artery pressure. This preference is based on concerns about inaccuracies and amplification of measurement errors that can occur from using derived variables. However, this has not been examined systematically. METHODS A retrospective database analysis was performed of invasively determined measurements of right heart pressure in 90 patients, corresponding echocardiographic estimations of pulmonary artery pressure, and additional parameters obtained within 24 hours. Several algorithms were compared for their correlations and accuracy parameters. RESULTS Although a Bland-Altman analysis demonstrated that all examined algorithms exhibited inaccuracies that could be clinically relevant in individuals, algorithms estimating mean pulmonary artery pressure (PAPm) on the basis of tricuspid regurgitation generally exhibited stronger correlations with invasively determined PAPm and more accurate identification of PH than did TR Vmax. Echocardiographic estimation of right atrial pressure >15 mm Hg exhibited the highest odds ratio for invasively confirmed PH, suggesting that this parameter is of additional diagnostic value. Indeed, algorithms that also considered right atrial pressure performed best, whereas empirical algorithms, TR Vmax, and methods relying on pulmonary acceleration time exhibited weaker performance. CONCLUSIONS Although all methods are associated with inaccuracies, echocardiographically determined PAPm was superior to the current guideline recommendation of using TR Vmax with regard to its correlation with invasively determined PAPm and the presence of PH. PAPm may be considered as an alternative to TR Vmax for evaluating the echocardiographic probability of PH.

中文翻译：

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超声心动图估计的平均肺动脉压：分配肺动脉高压可能性的不同方法的比较。

背景技术当前的指南建议使用超声心动图来无创地估计患者患有肺动脉高压（PH）的可能性。为了估计PH的超声心动图概率，建议将最大三尖瓣关闭不全速度（TR Vmax）作为主要参数，以用于提供肺动脉压估计的更复杂算法。此偏好基于对使用派生变量可能发生的测量误差的不准确性和放大的担忧。但是，这尚未得到系统地检查。方法采用回顾性数据库分析方法，对90例患者的右心压进行侵入性测定，并通过超声心动图估计肺动脉压，并在24小时内获得其他参数。比较了几种算法的相关性和准确性参数。结果尽管Bland-Altman分析表明，所有检查的算法均显示出可能与个体临床相关的误差，但是基于三尖瓣关闭不全估计平均肺动脉压（PAPm）的算法通常与侵入性测定的PAPm表现出更强的相关性，并且更准确地识别了PH比TR Vmax大。超声心动图估计的右房压> 15 mm Hg对侵入性确诊的PH表现出最高的优势比，表明该参数具有附加的诊断价值。确实，也考虑了正确心房压的算法效果最好，而经验算法TR Vmax 和依靠肺加速时间的方法表现较弱。结论尽管所有方法均与准确性不符，但超声心动图测定的PAPm在与侵入性测定的PAPm和PH的相关性方面优于目前使用TR Vmax的指南建议。PAPm可被视为TR Vmax的替代方案，用于评估PH的超声心动图概率。