D;Alto et al reported an echocardiographic score for evaluating a patient with heart failure for pulmonary vascular disease. The authors are from the Second University of Naples, Universite Libre de Bruxelles, Monaldi Hospital, San Giovanni di Dio e Ruggi d'Aragona University Hospital and Erasme University Hospital in Brussels.
Patient selection: heart failure
Analysis: echocardiography
The goal is to distinguish:
(1) Isolated postcapillary pulmonary hypertension (Ipc-PH)
(2) Combined pre- and post-capillary pulmonary hypertension (Cpc-PH)
(3) Precapillary pulmonary hypertension (Pre-PH)
(4) Postcapillary-pulmonary hypertension (Post-PH)
Parameters:
(1) E/e' ratio
(2) inferior vena cava (IVC) diameter in mm and collapsibility in percent
(3) right-to-left chamber ratio
(4) right ventricle forming the heart apex
(5) left ventricular eccentricity index (LVEI )
|
Parameter
|
Finding
|
Points
|
|
E/e' ratio
|
> 10
|
0
|
|
|
<= 10
|
2
|
|
inferior vena cava
|
diameter > 20 mm and less than 50% collapsibility
|
2
|
|
|
other
|
0
|
|
right to left chamber ratio
|
<= 1
|
0
|
|
|
> 1
|
1
|
|
RV forming the heart apex
|
no
|
0
|
|
|
yes
|
1
|
|
LVEI
|
< 1.2
|
0
|
|
|
>= 1.2
|
1
|
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
|
Score
|
Diastolic Pressure Gradient in mm Hg
|
Diagnosis
|
|
0 to 2.5
|
1 to 5
|
Ipc-PH
|
|
0.6 to 4.8
|
7 to 13
|
Cpc-PH
|
|
2.5 to 5.9
|
12 to 28
|
Pre-PH
|
|
0 to 3.3
|
1 to 9
|
Post-PH
|
