Echocardiographic Assessment of Pulmonary Hypertension in Patients with Advanced Lung Disease

Abstract

Doppler echocardiography is commonly used to estimate systolic pulmonary artery pressure and to diagnose pulmonary hypertension, but data relating to its utility in patients with advanced lung disease are limited. In a cohort study of 374 lung transplant candidates, the performance characteristics of echocardiography compared with right heart catheterization in the determination of systolic pulmonary artery pressure and diagnosis of pulmonary hypertension were investigated. The prevalence of pulmonary hypertension was 25% in the study population. Estimation of systolic pulmonary artery pressure by echocardiography was possible in 166 patients (44%). The correlation between systolic pulmonary artery pressure estimated by echocardiography and measured by cardiac catheterization was good (r = 0.69, p < 0.0001). However, 52% of pressure estimations were found to be inaccurate (more than 10 mm Hg difference compared with measured pressure), and 48% of patients were misclassified as having pulmonary hypertension by echocardiography. Sensitivity, specificity, and positive and negative predictive values of systolic pulmonary artery pressure estimation for diagnosis of pulmonary hypertension were 85%, 55%, 52%, and 87%, respectively. In conclusion, despite a statistically significant correlation with directly measured values, estimation of systolic pulmonary artery pressure by echocardiography is frequently inaccurate in patients with advanced lung disease and leads to considerable overdiagnosis of pulmonary hypertension.

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…Surrogate right ventricular parameters were also inaccurate compared with catheterization when measured. In the same study, only 56% of those with obstructive lung disease had an echocardiogramderived sPAP value within 10 mmHg of that determined by right heart catheterization [49]. Measures of cardiac chamber and major vessel sizes from standard CT images show a higher degree of sensitivity and specificity for PH than has been reported for echocardiography [50].…”

“…However, it has been shown that in patients with advanced lung disease, echocardiography is not comparable to the gold standard method of invasive right heart catheterization, frequently overestimating sPAP in those where a diagnostic echocardiographic view was possible [49]. In more than half of the study population, it was not possible to measure sPAP due to poor views.…”

Pulmonary Arterial Remodeling in Chronic Obstructive Pulmonary Disease is Lobe Dependent

“…Clearly, determining COPD to have a high transpulmonary gradient and correlating the vascular remodeling with pulmo-nary vascular resistance would lead to a more definitive study. Despite the well-documented concerns with using echocardiography to estimate pulmonary arterial pressures, especially in patients with COPD, 37,38 echocardiography remains the most accepted noninvasive tool for the assessment of PH in the clinical setting, 39 and echocardiographicdetermined PH has been associated with increased mortality among patients with COPD. 40 …”

Usefulness of Noninvasive Estimate of Pulmonary Vascular Resistance to Predict Mortality, Heart Failure, and Adverse Cardiovascular Events in Patients With Stable Coronary Artery Disease (from the Heart and Soul Study)

“…Second, use of TRV to estimate pulmonary artery systolic pressure may be prone to inaccuracy in certain patients. 10 Third, our estimation of PVR by TRV/VTI RVOT does not account for some potentially confounding hemodynamic variables including right atrial pressure and pulmonary capillary wedge pressure. However, previous validation studies correlating TRV/VTI RVOT to invasively measured PVR showed a robust correlation even in patients with increased right atrial pressure and pulmonary capillary wedge pressure.…”