Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease.
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.
Arcasoy
Selim M
SM
Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. sa2059@columbia.edu
Christie
Jason D
JD
Ferrari
Victor A
VA
Sutton
Martin St John
MS
Zisman
David A
DA
Blumenthal
Nancy P
NP
Pochettino
Alberto
A
Kotloff
Robert M
RM
D000328:Adult; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D003951:Diagnostic Errors; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008171:Lung Diseases / Q000150:complications*; D017563:Lung Diseases, Interstitial / Q000150:complications; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012680:Sensitivity and Specificity; D013997:Time Factors