Table 3

Advantages and disadvantages of (surrogate) echocardiographic measurements in PH

VariableMain advantagesMain disadvantages
Systolic PAP (mm Hg)Easily to perform; has been reported toDepends of angel of CW-Doppler interrogation;
(RVSP as a surrogatebe of prognostic value for PHPASP 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 TRPR required for PR velocity measurements
Diastolic PAP (mm Hg)Independent of RV systolic functionPR required for PR velocity measurements
TR peak velocityEstimation of RVSP; easy to obtainTrivial TR may allow accurate measurement
TRV >3.4 m/s—PH likelyof max. instantaneous TR gradient
S/D RatioS/D duration ratio >1.4—PH likelyRequires presence of defined TR onset/end
inversely correlates with survivalHeart rate and loading condition influenced
TAPSE (mm)Easily to perform; impaired RV functionDoes not take into account segmental or radial RV
—values <2 SD of age-related valuesfunction and contractility
Strain (%)Regional deformation provide informationRelative low temporal resolution that hinders
on regional myocardial dysfunction;tracking in the presence of high heart rates;
Strain rate (1/s)impaired RV longitudinal strainRequires a significant amount of
(<−12.5%)=greater PH severitypostprocessing time
3D echocardiographyFull 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 paediatricVariability with different loading conditions,
Patients with PH (proven by MRI data)assessment of motion in a single dimension
RV/LV diameter ratioEasily obtained in the clinical setting;Cannot be used in PH patients with
ratio >1—PH likelyleft-to-right shunt lesions
PAATCan be measured in 99% of patientsPossible pulmonary valve artefacts
Shortened <100 ms—PH likelyHeart 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.