Advantages and disadvantages of (surrogate) echocardiographic measurements in PH
| Variable | Main advantages | Main disadvantages |
|---|---|---|
| Systolic PAP (mm Hg) | Easily to perform; has been reported to | Depends of angel of CW-Doppler interrogation; |
| (RVSP as a surrogate | be of prognostic value for PH | PASP may be underestimated (eg, in patients |
| of the systolic PAP) | with severe TR) or may be overestimated | |
| Mean PAP (mm Hg) | At times better angle via PR than TR | PR required for PR velocity measurements |
| Diastolic PAP (mm Hg) | Independent of RV systolic function | PR required for PR velocity measurements |
| TR peak velocity | Estimation of RVSP; easy to obtain | Trivial TR may allow accurate measurement |
| TRV >3.4 m/s—PH likely | of max. instantaneous TR gradient | |
| S/D Ratio | S/D duration ratio >1.4—PH likely | Requires presence of defined TR onset/end |
| inversely correlates with survival | Heart rate and loading condition influenced | |
| TAPSE (mm) | Easily to perform; impaired RV function | Does not take into account segmental or radial RV |
| —values <2 SD of age-related values | function and contractility | |
| Strain (%) | Regional deformation provide information | Relative low temporal resolution that hinders |
| on regional myocardial dysfunction; | tracking in the presence of high heart rates; | |
| Strain rate (1/s) | impaired RV longitudinal strain | Requires a significant amount of |
| (<−12.5%)=greater PH severity | postprocessing time | |
| 3D echocardiography | Full volumetric data sets of the heart; | Dependent on adequate acoustic windows |
| RVEDV and EF measurements; | Only feasible in ∼50% of all patients | |
| S′ in TDI (cm/s) | easy to perform; decreased in paediatric | Variability with different loading conditions, |
| Patients with PH (proven by MRI data) | assessment of motion in a single dimension | |
| RV/LV diameter ratio | Easily obtained in the clinical setting; | Cannot be used in PH patients with |
| ratio >1—PH likely | left-to-right shunt lesions | |
| PAAT | Can be measured in 99% of patients | Possible pulmonary valve artefacts |
| Shortened <100 ms—PH likely | Heart rate dependent |
CW, continuous wave; PA, pulmonary artery; PAAT, pulmonary artery acceleration time; PAP, pulmonary artery pressure; PR, pulmonary regurgitation; PASP, pulmonary artery systolic pressure; RVSP, RV systolic pressure; S′, peak systolic velocity of the RV lateral wall; S/D ratio, systolic/diastolic ratio; TDI, tissue Doppler imaging; TR, tricuspid regurgitation; TRV, TR velocity; TAPSE, tricuspid annular plane systolic excursion.