Reliability of Echocardiographic Pulmonary Vascular Resistance to Screen for the New Definition of Precapillary Pulmonary Hypertension in Uncorrected Secundum Atrial Septal Defect

Background and Objective: The most feared complication of uncorrected secundum Atrial Septal Defect (ASD) is pulmonary arterial hypertension (PAH). Pulmonary vascular resistance (PVR) is crucial in detecting precapillary pulmonary hypertension (PH) to guide the need for PAH-specific therapy. There is a change in the cut-off value of PVR according to the recently updated PH guideline. How echocardiographic PVR (PVR<inf>echo</inf>) correlates to PVR by right heart catheterization (RHC) (PVR<inf>cath</inf>) according to the new guidelines has not been known. The aim of this study is to determine the reliability of PVR<inf>echo</inf> in detecting PAH in Uncorrected Ostium Secundum ASD based on the current updated guideline and to help screen the high PVR group. Methods: 429 ostium secundum ASD in the COngenital HeARt Disease in Adult and Pulmonary Hypertension (COHARD-PH) registry was divided into three groups according to the PVR. PVR<inf>echo</inf> was calculated using Abbas� Formula and compared the its gold standard, the PVR<inf>cath</inf>. The correlation between the two methods was analyzed. The Bland-Altman plot was used to analyze the agreement between the two methods. Receiver operating characteristics (ROC) analysis was used to determine the PVR<inf>echo</inf> cut-off value for high PVR. Results: The majority of the population (63.5) had high PVR. Female gender dominated the study population (84). PVR<inf>echo</inf> was significantly correlated with PVR<inf>cath</inf> (r = 0.6225, p < 0.0001). Bland-Altman plot among all groups and in subgroups analysis showed a wide range of agreement. PVR<inf>echo</inf> underestimated PVR<inf>cath</inf> 5.124 WU. In subgroup analysis, PVR<inf>echo</inf> overestimated PVR<inf>cath</inf> 0.35 WU in those with PVR < 2 WU. In the second and third groups, PVR<inf>echo</inf> underestimated PVR<inf>cath</inf> 0.52 and 10.77 WU, respectively. Conclusion: PVR<inf>echo</inf> is reliable in predicting high PVR in uncorrected secundum ASD. However, there is a wide range of agreement. PVR<inf>echo</inf> cut-off value of >1.62 WU showed good discriminatory power in determining high PVR. © 2024 Elsevier B.V., All rights reserved.