CHEST Guidelines-Lowering-Tricuspid-Regurgitant-Velocity-Threshold-

Lowering-Tricuspid-Regurgitant-Velocity-Threshold-

Pdf Summary

The editorial by Michael G. Risbano discusses recent findings and debates surrounding the best tricuspid regurgitant velocity (TRV) cutoff to screen for pulmonary hypertension (PH) in alignment with the updated PH definition of a mean pulmonary artery pressure (mPAP) of 20 mm Hg. Historically, PH was diagnosed at an mPAP ≥ 25 mm Hg, but recent research indicates that a normal mPAP is around 14 ± 3.3 mm Hg, lending credence to lowering the diagnostic threshold.<br /><br />The key study reviewed compares two TRV cutoff points, 2.7 m/s and 3.4 m/s, employing data from large retrospective cohorts at the Cleveland Clinic and Stanford University. Montané et al. advocate for using a TRV of 2.7 m/s to improve the sensitivity of PH screening, while Gall et al. from Germany highlight that a lower TRG cutoff compromises the test’s positive predictive value (PPV), suggesting the formerly higher cutoff performs better. Despite different conclusions, all agree further research is needed to validate optimal TRV thresholds.<br /><br />Risbano notes that this shift to a lower TRV cutoff in screening, without comprehensive prospective trials, could lead to increased right heart catheterizations (RHCs). This could strain healthcare resources without clear established benefits for mortality or morbidity unless institutional prevalences and patient-specific factors are considered.<br /><br />The discussion also highlights the potential for generic vasodilators to treat borderline PH, albeit with reservations due to a lack of established data. Ultimately, the article suggests a more tailored approach to PH screening may be beneficial, recognizing the need for a prospective study to determine the optimal TRV cutoff, though such an initiative may not occur soon.

Keywords

tricuspid regurgitant velocity

pulmonary hypertension

mean pulmonary artery pressure

TRV cutoff

screening

right heart catheterizations

vasodilators

sensitivity

positive predictive value

prospective study