Echocardiographic TRJV > 3.4 m/s indicated high pulmonary hypertension probability, yet only 34% of these patients had PH documented in final reports and 5% received specialty referrals.
Observational (n=2,696)
Yes
There is a significant clinical gap in the documentation and subsequent referral of patients with echocardiographic signs of high pulmonary hypertension probability, representing a missed opportunity for early diagnosis and management.
Abstract Introduction Right heart catheterization (RHC) remains the gold standard for diagnosing pulmonary hypertension (PH), yet it is often performed late in the disease course, leading to significant morbidity. Tricuspid regurgitation jet velocity (TRJV) measured by echocardiography offers an early, noninvasive approach for screening and detection of PH. However, TRJV reflecting PH probability is frequently under reported in final echocardiogram interpretations, delaying diagnostic evaluation. This study aimed to determine the prevalence of high PH probability based on TRJV findings, assess the frequency of PH documentation in final reports, and examine referral patterns to Cardiology or Pulmonology for further diagnostic testing and management across Geisinger Medical Centers. Methods A retrospective correlation analysis was conducted on 2,696 adult patients who underwent echocardiography between January 1, 2022, and January 1, 2024. TRJV 3.4 m/s was used to define high PH probability. Patients meeting this criterion were evaluated for PH documentation, specialty referral, and confirmatory workup including RHC. Statistical analysis included Spearman correlation coefficients and 95% confidence intervals (CIs). Results Among 2696 patients that had echocardiograms performed for various indications with TRJV 3.4 m/s, meeting criteria for high likelihood of PH, only 913 (34%; 95% CI: 32.1-35.7) had PH probability documented in the final report, while 1,638 (60%; 95% CI: 58.9-62.6) lacked documentation. Only 134 patients (5%) had specialty referrals for further evaluation, while 1,750 (65%; 95% CI: 63.1-66.7) were not. RHC was performed in 261 (10%) patients, confirming PH in 235 (90%; 95% CI: 86.4-93.7), including 62 (26%; 95% CI: 20.7-32.0) with pre-capillary PH. A moderate but statistically significant correlation was observed between TRJV and RHC mean pulmonary artery pressure diagnostic parameter (r = 0.24, p 0.0001). Conclusion TRJV 3.4 m/s demonstrated a high positive predictive value for PH; however, a substantial number of high-probability patients were neither documented nor referred for further evaluation. These findings highlight critical gaps in recognition and referral pathways. One of several suggestions include integrating automated alerts for elevated TRJV values during echocardiography interpretation and documentation to facilitate early PH detection, expedite specialty referral and improve patient outcomes. This abstract is funded by: None
Moyo et al. (Fri,) conducted a observational in Pulmonary hypertension (n=2,696). Echocardiography (TRJV > 3.4 m/s) was evaluated on Documentation of pulmonary hypertension probability in final echocardiogram reports (95% CI 32.1-35.7). Echocardiographic TRJV > 3.4 m/s indicated high pulmonary hypertension probability, yet only 34% of these patients had PH documented in final reports and 5% received specialty referrals.