The Utility of Echocardiography in Patients with Pulmonary Hypertension Secondary to Idiopathic bronchiectasis

Abstract

Abstract Background Pulmonary hypertension (PH) is a critical complication in bronchiectasis. However, the optimal noninvasive test for evaluating PH in bronchiectasis patients remains unknown. Methods This study included patients with idiopathic bronchiectasis who received right heart catheterization (RHC) to evaluate the consistency between pulmonary arterial pressure (PAP) and other noninvasive indicators (pulmonary artery systolic pressure [PASP] calculated by echocardiography, main pulmonary artery [MPA] diameter, and MPA/ascending aorta ratio on chest high-resolution computed tomography). It determined the optimal noninvasive indicator for identifying PH and its critical point according to the Youden Index, which were then used to investigate the proportion, risk factors, and prognostic value of PH in patients with idiopathic bronchiectasis in another large-scale population. Results Based on data from 82 patients with idiopathic bronchiectasis who received RHC, the PASP demonstrated the best correlation and consistency with the mean or systolic PAP, with a critical point of 44 mmHg. According to this critical point, the predicted proportion of PH was 11.3% (182/1606) in another idiopathic bronchiectasis population. Regression analyses showed that age, cystic or mixed type, and N-terminal pro-brain natriuretic peptide (N-proBNP) were independent risk factors for PH in patients with idiopathic bronchiectasis. Follow-up data showed that mortality was higher in patients with idiopathic bronchiectasis with (n = 182; 24 deaths) than without (n = 1424; 101 deaths) PH (log-rank test = 7.783, P = 0.0053) diagnosed using the PASP. Conclusion Our findings suggest that echocardiography is a noninvasive and dependable tool for identifying PH in patients with idiopathic bronchiectasis. (ClinicalTrials.gov number, NCT03883048).