ArticleEcho research and practice2022
IMproving PULmonary hypertension Screening by Echocardiography: IMPULSE.
Article in Echo research and practice, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 13 citations in OpenAlex.
- Cardiopulmonary transit time measured on dynamic rubidium cardiac PET/CT is a predictor for pulmonary hypertension.EJNMMI research · 2026Article
- Significance of echocardiographic metrics including TRV and TAPSE/SPAP in mild haemodynamic pulmonary hypertension - data from EVIDENCE-PAH UK.Echo research and practice · 2026Article
- The impact of right ventricular free wall strain on current international echocardiography guidelines for the assessment of pulmonary hypertension.Echo research and practice · 2026Article
- Performance of Guideline-Recommended Approaches to Echocardiographic Investigation for Pulmonary Hypertension: Analysis of the CIPHER Study.Pulmonary circulation · 2026Article
- Challenges and opportunities in assessing right ventricular structure and function: a Roadmap for standardization, clinical implementation and research.Nature reviews. Cardiology · 2026Review
- Towards an integrated and proactive management of pulmonary hypertension in systemic sclerosis: a practical approach for early diagnosis and optimal patient management.Rheumatology advances in practice · 2026Review
- Artificial intelligence-based echocardiography assessment to detect pulmonary hypertension.ERJ open research · 2025Article
- Analysis of clinical characteristics of patients with pulmonary hypertension in Chaya County, Chamdo, Tibet.Cardiovascular diagnosis and therapy · 2024Article
- Prognostic values of right ventricular echocardiography functional parameters for mortality prediction in precapillary pulmonary hypertension: a systematic review and meta-analysis.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2024Review
- Two prospective, multicenter studies for the identification of biomarker signatures for early detection of pulmonary hypertension (PH): The CIPHER and CIPHER-MRI studies.Pulmonary circulation · 2024Article
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Authors and funding
16 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundThe world symposium on pulmonary hypertension (PH) has proposed that PH be defined as a mean pulmonary artery pressure (mPAP) > 20 mmHg as assessed by right heart catheterisation (RHC). Transthoracic echocardiography (TTE) is an established screening tool used for suspected PH. International guidelines recommend a multi-parameter assessment of the TTE PH probability although effectiveness has not been established using real world data. STUDY
aimsTo determine accuracy of the European Society of Cardiology (ESC) and British Society of Echocardiography (BSE) TTE probability algorithm in detecting PH in patients attending a UK PH centre. To identify echocardiographic markers and revised algorithms to improve the detection of PH in those with low/intermediate BSE/ESC TTE PH probability.
methodsTTE followed by RHC (within 4 months after) was undertaken in patients for suspected but previously unconfirmed PH. BSE/ESC PH TTE probabilities were calculated alongside additional markers of right ventricular (RV) longitudinal and radial function, and RV diastolic function. A refined IMPULSE algorithm was devised and evaluated in patients with low and/or intermediate ESC/BSE TTE PH probability.
resultsOf 310 patients assessed, 236 (76%) had RHC-confirmed PH (average mPAP 42.8 ± 11.7). Sensitivity and specificity for detecting PH using the BSE/ESC recommendations was 89% and 68%, respectively. 36% of those with low BSE/ESC TTE probability had RHC-confirmed PH and BSE/ESC PH probability parameters did not differ amongst those with and without PH in the low probability group. Conversely, RV free wall longitudinal strain (RVFWLS) was lower in patients with vs. without PH in low BSE/ESC probability group (- 20.6 ± 4.1% vs - 23.8 ± 3.9%) (P < 0.02). Incorporating RVFWLS and TTE features of RV radial and diastolic function (RVFAC and IVRT) within the IMPULSE algorithm reduced false negatives in patients with low BSE/ESC PH probability by 29%. The IMPULSE algorithm had excellent specificity and positive predictive value in those with low (93%/80%, respectively) or intermediate (82%/86%, respectively) PH probability.
conclusionExisting TTE PH probability guidelines lack sensitivity to detect patients with milder haemodynamic forms of PH. Combining additional TTE makers assessing RV radial, longitudinal and diastolic function enhance identification of milder forms of PH, particularly in those who have a low BSE/ESC TTE PH probability.
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