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Echocardiographic measures of pulmonary hypertension and the prediction of end‐points in sickle cell disease
Author(s) -
Victor K.,
Harden F.,
Mengersen K.,
Howard J.,
Chambers J. B.
Publication year - 2016
Publication title -
sonography
Language(s) - English
Resource type - Journals
eISSN - 2054-6750
pISSN - 2202-8323
DOI - 10.1002/sono.12050
Subject(s) - medicine , pulmonary hypertension , cardiology , pulmonary artery , regurgitation (circulation)
The peak tricuspid valve regurgitation jet velocity (TR Vmax) on transthoracic echocardiography (TTE) is used as a screen for pulmonary hypertension (PHT). Our aims were to determine the following: how often TR Vmax was measurable in patients with sickle cell disease (SCD), whether other TTE measures were useful and the ability of TTE to predict end‐points. Methods This was a retrospective analysis of 504 patients (aged 17–81 years) referred from a tertiary centre SCD clinic between 2007 and 2014. Data included clinical parameters, echocardiographic assessment, physical evaluation, laboratory results and medical consultation. End‐points were death, PHT on right heart catheterisation and sickle cell crisis requiring hospital admission. Results Tricuspid regurgitant signal was measurable in 443 (44%) out of 1002 TTEs. No TTE measure definitively predicted end‐points ( P > 0.05). However, pulmonary artery acceleration time (measurable in 62% of TTEs) was the best single predictor of end‐points with a sensitivity 97% and specificity 9% (Fisher's dot test, P = 0.03). Discussion In a large, unselected population with SCD, TR Vmax was measurable in less than one‐half of studies. No echocardiographic measure reliably predicted end‐points. It was found that pulmonary artery acceleration time was a potentially useful tool when assessing SCD patients and may be worth investigating prospectively.