Accuracy and precision of echocardiography versus right heart catheterization for the assessment of pulmonary hypertension
Section snippets
Background
Doppler echocardiography allows for estimates of pulmonary artery pressure (PAP), left atrial pressure (LAP) and cardiac output (Q), and thus for the calculation of pulmonary vascular resistance (PVR) [1]. Progress in technology and development of portable devices have made it possible to use Doppler echocardiography for the exploration of the effects of environmental stress on the pulmonary circulation, such as exercise [2], [3], [4] and hypoxia [5]. Interestingly, in these studies on normal
Methods
The study enrolled prospectively all consecutive patients referred to Pulmonary Hypertension Unit of Monaldi Hospital, Naples, Italy, between 1st June 2011 and 31st May 2012 for a suspicion of pulmonary hypertension who underwent a right heart catheterization. All of them gave an informed consent to the study, which was approved by the Institutional Review Board. The presence of an uncorrected intra- or extra-cardiac shunt, insufficient quality of echo imaging, an estimated systolic pressure at
Results
Nine out of 161 (5.6%) patients were excluded due to insufficient quality of echo imaging. No patient showed indirect echocardiographic signs of pulmonary hypertension in the presence of an estimated sPAP < 37 mm Hg. The demographics of the other 152 patients are summarized in Table 1. The majority of the patients had pulmonary arterial hypertension (PAH, 36%) or pulmonary venous hypertension (PVH, 40%) on left heart conditions. Ten patients (7%) did not meet the diagnostic criteria for pulmonary
Discussion
The present results indicate that trans-thoracic Doppler echocardiography compared to right heart catheterization is accurate and thus allows for valid population studies, but may be insufficiently precise for the diagnosis and estimation of severity of pulmonary hypertension on an individual basis.
Many previous studies aiming at the validation of Doppler echocardiographic measurements of pulmonary vascular pressures and flows relied on correlation calculations [9], [10], [11], [16], [17], [19]
References (31)
- et al.
Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis
J Am Soc Echocardiogr
(2013 Jan) - et al.
Exercise stress echocardiography of the pulmonary circulation: limits of normal and gender differences
Chest
(2012) - et al.
Exercise pathophysiology in patients with chronic mountain sickness
Chest
(2012) - et al.
Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension
Chest
(2011) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
J Am Soc Echocardiogr
(2010) - et al.
New formula for predicting mean pulmonary artery pressure using systolic pulmonary artery pressure
Chest
(2004) - et al.
Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures
J Am Coll Cardiol
(1997) - et al.
Magnitude and implications of spontaneous hemodynamic variability in primary pulmonary hypertension
Am J Cardiol
(1985) - et al.
Misclassification of pulmonary hypertension due to reliance on pulmonary capillary wedge pressure rather than left ventricular end-diastolic pressure
Chest
(2009)
Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function at exercise
J Appl Physiol
Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals
J Physiol
Approach to the patient with pulmonary hypertension
Pulmonary artery pressure during rest and exercise in healthy subjects: a systematic review
Eur Respir J
Distensibility of the normal human lung circulation during exercise
Am J Physiol Lung Cell Mol Physiol
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.