Chest
Volume 139, Issue 5, May 2011, Pages 988-993
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Original Research
Pulmonary Vascular Disease
Inaccuracy of Doppler Echocardiographic Estimates of Pulmonary Artery Pressures in Patients With Pulmonary Hypertension: Implications for Clinical Practice

https://doi.org/10.1378/chest.10-1269Get rights and content

Background

Recent studies suggest that Doppler echocardiography (DE)-based estimates of pulmonary artery systolic pressure (PASP) may not be as accurate as previously believed. We sought to determine the accuracy of PASP measurements using DE compared with right-sided heart catheterization (RHC) in patients with pulmonary hypertension (PH).

Methods

We compared DE estimates of PASP to invasively measure PASP during RHC in 160 consecutive patients with PH (part one). To account for possible changes in hemodynamics between DE and RHC, we then prospectively determined PASP in an additional 23 consecutive patients undergoing simultaneous RHC and DE (part two). Bland-Altman analyses were performed to evaluate the agreement between RHC and DE measurements of PASP. Accuracy was predefined as 95% limits of agreement within ± 10 mm Hg for PASP estimates.

Results

In part one, there was moderate correlation between DE and RHC measurements of PASP (r = 0.68, P < .001). However, using Bland-Altman analysis, the bias for DE estimates of PASP was 2.2 mm Hg with 95% limits of agreement ranging from −34.2 to 38.6 mm Hg. DE estimates of PASP were determined to be inaccurate in 50.6% of patients. In part two, there was moderate correlation between DE and RHC measurements of PASP (r = 0.71, P < .01). However, despite simultaneous DE and RHC measurements, the bias for DE estimates of PASP was 8.0 mm Hg with 95% limits of agreement ranging from −28.4 to 44.4 mm Hg.

Conclusions

DE estimates of PASP are inaccurate in patients with PH and should not be relied on to make the diagnosis of PH or to follow the efficacy of therapy.

Section snippets

Materials and Methods

The institutional review board at the University of Chicago (approval number 15271A) approved the conduct of this study, and all patients provided written consent prior to enrollment. This study was conducted in two parts.

Results

The baseline characteristics of the patients in this study can be seen in Table 1. The majority of patients were women who received a diagnosis of World Health Organization group 1 PAH, although patients with other causes of PH were also included in this study. The hemodynamics obtained during RHC and DE are summarized in Table 2. A wide range of PASP (20 mm Hg to 120 mm Hg) and RAP (1 mm Hg to 35 mm Hg) during RHC was observed. In a small minority of the patients, the RHC assessment of

Discussion

In this study of patients with PH, we found that PASP measurements as estimated by DE were inaccurate when compared with PASP determined by RHC. This suggests that DE should not be used to diagnose PH or to determine the response to medical therapy in patients with PH.

The development of quantitative Doppler measurements from TR jets observed on echocardiograms has had a dramatic impact on the clinical diagnosis of PH. In 1984, Yock et al16 reported that quantitation of the regurgitant tricuspid

Conclusions

In conclusion, we have confirmed that DE estimates of PASP in patients with PH are inaccurate compared with RHC-based measurements. Echocardiography is a useful screening tool for suspected PH, but the definitive diagnosis and follow-up hemodynamic assessments should be performed with RHC. In particular, DE estimates of PASP should not be relied on when making management decisions.

Acknowledgments

Author contributions: Dr J. D. Rich: contributed to the design of the study, data collection and analyses, and drafting of the manuscript.

Dr Shah: contributed to data collection and analyses and revisions to the manuscript.

Dr Swamy: contributed to data collection and revisions to the manuscript.

Dr Kamp: contributed to data collection and revisions to the manuscript.

Dr S. Rich: contributed to the design of the study, data collection and analyses, and revisions to the manuscript.

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