Accuracy of Echocardiographic Parameters in Diagnosing Pulmonary Hypertension in Adult Patients With Uncorrected Secundum Atrial Septal Defect

PURPOSE: Pulmonary hypertension (PH) is a progressive complication in adults with atrial septal defect (ASD), significantly impacting prognosis. Although right heart catheterization (RHC) is the gold standard for diagnosis, it is invasive. This study aimed to evaluate the diagnostic accuracy of various echocardiographic parameters compared to RHC for detecting PH specifically in adult patients with uncorrected secundum ASD. METHODS: This cross-sectional diagnostic study utilized retrospective data from the COngenital HeARt Disease in adult and Pulmonary Hypertension (COHARD-PH) registry at Sardjito Hospital, Indonesia. The subjects were adult patients with uncorrected secundum ASD who underwent both echocardiography and RHC between January 2023 and July 2025. PH was established based on RHC, defined as mean pulmonary artery pressure (mPAP) > 20 mm Hg. ROC curve analysis and 2 × 2 tables were used to determine the cutoff values, sensitivity, specificity, and accuracy of echocardiographic parameters using RHC as the gold standard. RESULTS: The study included 97 subjects, with 87 subjects (89.7%) suffering from PH. The echocardiographic parameters with the best accuracy for diagnosing PH were PVR estimation (84.54%), TRV (81.45%), TRPG (81.44%), as well as PASP, mPAP, and the TAPSE/PASP ratio (80.41%). The optimal TRV cutoff value for detecting PH was ≥2.96 m/s (sensitivity 81.6%, specificity 80%). CONCLUSION: Pressure and resistance based echocardiographic parameters, namely, TRV, TRPG, PASP, mPAP, the TAPSE/PASP ratio, and PVR estimation, demonstrate good accuracy in diagnosing PH in adult patients with uncorrected secundum ASD. A TRV cutoff of ≥2.96 m/s improves specificity in this population.