Automated Measures Enhance Pulmonary Hypertension Diagnosis
A groundbreaking study published in Respiratory Medicine reveals meaningful limitations in visually identifying interventricular septal (IVS) flattening in patients with pulmonary hypertension (PH), a serious cardiovascular condition.Researchers are advocating for the adoption of automated measures to improve diagnostic accuracy and patient outcomes.
IVS flattening, a key indicator of PH, is characterized by a flattened appearance of the wall separating the heart’s left and right ventricles on an echocardiogram. This flattening signals increased pressure or volume overload in the right ventricle, often associated with worse outcomes in various cardiovascular diseases, including severe tricuspid regurgitation and pulmonary arterial hypertension. “Despite it’s incorporation into PH guidelines and clinical care, little is known about the reliability, accuracy, and test characteristics of the visual assessment and quantification of IVS flattening,” the researchers noted.
Previous research on inter-observer agreement for visual IVS flattening assessment showed good agreement (Kappa of 0.78), but suffered from limitations including a small sample size (60 patients) and incomplete details on patient characteristics and assessment methods.This new study, conducted at a single U.S. center, aimed to address these shortcomings.
The study involved 173 patients. Two autonomous board-certified echocardiographers visually assessed IVS flattening, while an eccentricity index (EI) provided a quantitative measure. The researchers found that an EI cutoff of 1.5 offered the best balance between specificity (80%) and sensitivity (32%) when compared to visual assessment. Visual assessment, while demonstrating high specificity, showed significantly lower sensitivity.
Using an EI cutoff of at least 1.1 at end-systole, visual assessment had a sensitivity of only 39% (95% CI, 23%-36%) and a specificity of 85% (95% CI, 77%-90%). The negative predictive value was 44% (95% CI, 46%-57%), and the positive predictive value was 73% (95% CI, 63%-80%). These findings suggest that visual assessment may lead to many cases of IVS flattening being missed.
“This study underscores the need for more reliable and accurate methods for detecting IVS flattening in PH patients,” said [Insert name and title of lead researcher, if available].”Automated measures, like the EI, offer a promising approach to improve diagnostic accuracy and potentially lead to earlier and more effective interventions.”
The implications of this research are significant for improving the diagnosis and management of PH in the United States. Early and accurate diagnosis is crucial for effective treatment and improved patient outcomes. The study’s findings highlight the potential of automated measures to revolutionize the detection of this critical indicator of PH.
Echocardiogram Readings for Interventricular Septal Flattening Show Variability in Pulmonary Hypertension
A recent study published in Respiratory Medicine reveals inconsistencies in how cardiologists interpret echocardiograms when assessing interventricular septal (IVS) flattening in patients with pulmonary hypertension (PH). This finding underscores the need for standardized diagnostic criteria and could impact treatment strategies for this serious condition.
The research, which analyzed data from multiple echocardiogram readers, found a significant degree of variability in the visual assessment of IVS flattening. A Bland-Altman analysis showed a 95% limits of agreement ranging from –0.72 to 1.23, indicating substantial disagreement between interpretations.
While overall agreement between the two echocardiogram readers was observed, the level of agreement varied significantly depending on the type of PH. For patients with precapillary PH, agreement was moderate (80% agreement; κ = 0.51; P = .0001). Though, agreement was only fair for those with combined pre- and postcapillary PH (73% agreement; κ = 0.31; P = .007), and poor for patients with isolated postcapillary PH (66% agreement; κ = –0.07; P = .83).
“Interestingly, the level of agreement in visual IVS flattening between echo readers seemed to differ based on pulmonary vascular resistance, with highest agreement for patients with pre-capillary and Cpc-PH, which are both characterized by an elevated [pulmonary vascular resistance],” the researchers noted. “In contrast, there was a lack of agreement in visual IVS flattening for patients with isolated post-capillary PH. This may have relevance when incorporating IVS flattening in echo scoring systems used to distinguish between PAH and LHD-PH.”
The implications of this variability are significant. Accurate diagnosis of PH subtypes is crucial for effective treatment, and inconsistent interpretation of echocardiograms could lead to delayed or inappropriate interventions. This research highlights the need for further examination into improving the reliability and standardization of echocardiographic assessment of IVS flattening in PH.
The study’s findings could have far-reaching consequences for patients across the U.S., impacting the quality of care and potentially delaying appropriate treatment for those suffering from this often-debilitating condition. Further research is needed to develop more precise and consistent methods for interpreting echocardiograms in PH patients.
References
- Rahman M, Jakkoju A, Mohsen AM, et al. Inter observer reliability and accuracy of the visual assessment of interventricular septal flattening in pulmonary hypertension.Respir Med. Published online November 13,2024. doi:10.1016/j.rmed.2024.107858
- Omori T, Maeda M, Kagawa S, et al. Impact of diastolic interventricular septal flattening on clinical outcome in patients with severe tricuspid regurgitation. JAHA. 2021;10(20):e021363. doi:10.1161/JAHA.121.021363
- Ghio S, Klersy C, Magrini G, et al.Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension. Int J Cardiol. 2008;140(3):272-278. doi:10.1016/j.ijcard.2008.11.051
