Accuracy of Doppler-derived pulmonary artery hypertension to predict heart failure with normal ejection fraction

Abstract 

Recent advances have highlighted the clinical relevance of pulmonary artery hypertension in terms of diagnosis and prognosis in heart failure with normal ejection fraction. We addressed the usefulness of Doppler-derived pulmonary artery systolic pressure to predict heart failure with normal ejection fraction in stable patients with exertional dyspnea. 25 patients referred for clinically indicated catheterism with evidence of heart failure according to the European diagnostic flowchart on “how to diagnose heart failure with normal ejection fraction” and 12 controls referred for clinically indicated catheterism without this condition according to the diagnostic flowchart on “how to exclude heart failure with normal ejection fraction” were included. None of the patients presented with Doppler-derived pulmonary vascular resistance >2.5WU. By logistic regression analysis, pulmonary artery systolic pressure predicted heart failure with normal ejection fraction (p=0.006), with an optimal cut-off value of 35mmHg (area under the ROC curve of 0.80 [0.64–0.92], p<0.001; sensitivity 76%, specificity 75%). Positive and negative predictive values were 93 and 50% for the cut-off value of 40mmHg. Doppler-derived pulmonary artery hypertension is a landmark of heart failure with normal ejection fraction in patients without severely increased pulmonary vascular resistance and deserves further attention in upcoming international recommendations.

Keywords: Diastolic heart failure, Pulmonary artery hypertension, Doppler echocardiography