Diagnose underlying diseases in patients with high probability of pulmonary hypertension by combined echocardiography.

Abstract

Background: In the literature on the diagnosis and treatment of pulmonary hypertension (PH), transthoracic echocardiography (TTE) is only used for risk assessment, cardiac function evaluation and prognosis judgment of pulmonary hypertension, and rarely mentioned for the diagnosis of underlying diseases. To investigate the effect of combined echocardiography on the diagnosis of underlying diseases in patients with high probability of PH.

Methods: 64 patients with high probability of PH assessed by TTE without definite diagnosis of underlying diseases were enrolled. Each patient underwent TTE, low-dose agitated saline contrast echocardiography (ASCE), transesophageal echocardiography (TEE), and low-dose ASCE in a single sequence. Ultrasonic diagnosis was divided into TTE combined with low-dose ASCE group and low-dose ASCE combined with TEE group, with clinical comprehensive diagnosis as the gold standard, evaluated diagnostic efficiency of the different combinations to the underlying diseases.

Results: The sensitivity and specificity of low-dose ASCE combined with TEE in detecting underlying diseases were 86.49% and 100%, respectively. The rate of missed diagnosis by TTE combined with low-dose ASCE was 5.6-fold by low-dose ASCE combined with TEE. The compliance rate between low-dose ASCE combined with TEE and the gold standard was 92.19%. When low-dose ASCE combined with TEE is positive, the possibility of identifying underlying diseases is 100%, otherwise, the probability of idiopathic or unknown/multifactorial PH was 84.3%.

Conclusion: The echocardiography of low dose ASCE combined with TEE can safely and efficiently assist diagnosis of underlying disease in patients with high probability of PH.