Uncertainty analysis in hemodynamic variables measurement for reliable diagnosis of Pulmonary Hypertension with non-invasive techniques

In the paper the authors propose a procedure for accurate interpretation of hemodynamic indexes in the diagnosis of Pulmonary Hypertension (PH). Non-invasive estimation of PH is possible by using continuous-wave Doppler Echocardiography. Such method allows measures of tricuspid regurgitation velocity to be obtained. In this way by means of Bernoulli equation, some pulmonary hemodynamic variables can be estimated (systolic and mean pulmonary artery pressure, pulmonary vascular resistance, pulmonary capillary wedge pressure and cardiac output). In clinical practice, the “ESC/ERS Guidelines on diagnosis and treatment of pulmonary arterial” provide different hemodynamic definitions of PH according to various combinations of the previous variables. Cut-off values have been fixed so to guide the physicians during the diagnosis. Unfortunately Doppler-derived pressure estimation may be inaccurate. Consequently, underestimations or overestimations of the pulmonary artery pressure levels are cause of false-negative and false-positive diagnoses, respectively. In order to optimize the criteria at present used for detecting the presence of PH, an original technique is described. The procedure is based on the analysis of measurement uncertainty. The aim is to ensure a reliable interpretation of the echocardiographic variables for fault-tolerant diagnoses.