According to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterisation (RHC). How echocardiography predicts PH recently redefined by mean pulmonary arterial pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by pulmonary vascular resistance (PVR) ≥3 or >2 WU has not been established.

A total of 278 patients referred for PH underwent comprehensive echocardiography followed by RHC. 15 patients (5.4%) were excluded because of insufficient quality echocardiography.

With PH defined by mPAP >20 mmHg, 23 patients had no PH, 146 had pre-capillary PH and 94 had post-capillary PH. At univariate analysis, maximum tricuspid regurgitation velocity (TRV) 2.9–3.4 m·s^–1, left ventricle (LV) eccentricity index >1.1, right ventricle outflow tract acceleration time (RVOT-AT) <105 ms or notching, RV/LV basal diameter >1 and pulmonary artery diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m·s^–1 independently predicted PH. Additional independent prediction of PVR ≥3 WU was offered by LV eccentricity index >1.1, and RVOT-AT <105 ms and/or notching, but with no improvement of optimal combination of specificity and sensitivity or positive prediction.

Echocardiography as recommended in current guidelines can be used to assess the probability of redefined PH in a referral centre. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.

根据目前的指南，肺动脉高压 (PH) 的诊断依赖于超声心动图概率，然后是右心导管 (RHC)。超声心动图如何预测最近通过平均肺动脉压 (mPAP) >20 mmHg 而不是≥25 mmHg 重新定义的 PH 以及由肺血管阻力 (PVR) ≥3 或 >2 WU 定义的肺血管疾病尚未确定。

共有 278 名因 PH 转诊的患者接受了综合超声心动图检查，随后进行了 RHC。15 名患者（5.4%）因超声心动图质量不足而被排除。

在 mPAP > 20 mmHg 定义的 PH 中，23 名患者没有 PH，146 名患有毛细血管前 PH，94 名患有毛细血管后 PH。在单变量分析中，最大三尖瓣反流速度 (TRV) 2.9–3.4 m·s ^–1，左心室 (LV) 偏心率指数 >1.1，右心室流出道加速时间 (RVOT-AT) <105 ms 或切迹，RV/LV基底直径 > 1 和肺动脉直径预测 PH，而下腔静脉直径和右心房面积没有。在多变量分析中，只有 TRV ≥2.9 m·s ^–1独立预测 PH。LV 偏心率指数 >1.1 和 RVOT-AT <105 ms 和/或切口提供了 PVR ≥3 WU 的额外独立预测，但特异性和灵敏度的最佳组合或阳性预测没有改善。

当前指南中推荐的超声心动图可用于评估转诊中心重新定义 PH 的可能性。然而，间接体征的附加价值不大，部分患者可能无法恢复足够质量的超声心动图信号。