D'Alto et al developed an echocardiographic score for distinguishing pre- from postcapillary pulmonary hypertension. The authors are from multiple institutions in Italy and Belgium.
Patient selection: pulmonary hypertension
Parameters:
(1) right heart chambers versus left (based on sum of atrial and ventricular dimensions)
(2) left ventricular eccentricity index (EI)
(3) inferior vena cava (IVC) diameter and collapsibility during inspiration
(4) left heart E/e' ratio (E wave and e' wave in cm/sec)
(5) right ventricle forming apex
Parameter
Finding
Points
relative diameters of right and left ventricles
right > left
3
right <= left
0
left ventricular EI
< 0.9
0
>= 0.9
4
inferior vena cava
collapsibility > 50% and diameter <= 20 mm
0
collapsibility <= 50% and diameter > 20 mm
10
E/e' ratio
<= 10
16
> 10
0
right ventricle forming apex
no
0
yes
1
Interpretation:
• minimum score: 0
• maximum score: 34
• A score > 5 was associated with precapillary pulmonary hypertension.
Performance:
• The area under the ROC curve was 0.76.
• The positive predictive value was 68%.
• The negative predictive value was 78%.
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