title: Estimation of pulmonary pressures and diagnosis of pulmonary hypertension by Doppler echocardiography: a retrospective comparison of routine echocardiography and invasive hemodynamics.
abstract: BACKGROUND
  To date, Doppler echocardiography is the most widespread and well-recognized technique for the noninvasive evaluation of systolic pulmonary artery pressure (sPAP). However, recent studies have reported reservations about the relevance of Doppler echocardiography or the tool's reliability in the diagnosis and follow-up of patients with pulmonary hypertension (PH). Thus, the aim of this dedicated retrospective study was to address the questions of Doppler echocardiography's relevance and accuracy for PH diagnosis in the routine activity of a conventional echocardiography department.
  
  
  METHODS
  Institutional databases were used to extract and analyze the records of 310 patients who underwent both hemodynamic and echocardiographic investigations within a single hospitalization period.
  
  
  RESULTS
  Despite an underestimation of absolute Doppler sPAP values compared with measurements on right heart catheterization, data analysis revealed a strong correlation (r = 0.80, P < .00001, n = 310). Targeting a mean pulmonary pressure on right heart catheterization of 25 mm Hg for the definition of PH, receiver operating characteristic curve analysis demonstrated a strong association between sPAP and PH diagnosis (area under the curve, 0.82; n = 155). The cutoff obtained for sPAP was 38 mm Hg, and when applied on a second-test subgroup population (n = 155), sensitivity, specificity, and accuracy were 88%, 83%, and 86%, respectively. When patients with examination intervals of <2 days were selected (n = 115), sensitivity and specificity reached 89% and 89%, respectively. No combination of parameters produced an improvement on the initial results.
  
  
  CONCLUSIONS
  In the real-world practice of a conventional echocardiography department, Doppler echocardiography is associated with high accuracy, sensitivity, and specificity for PH evaluation, thus confirming its major position as a primary noninvasive tool.
authors.affiliation: Université de Bordeaux, CHU de Bordeaux, CIC 0005, Bordeaux, France. stephane.lafitte@chu-bordeaux.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lafitte
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.forename: Patricia
authors.initials: P
authors.lastname: Reant
authors.forename: Francois
authors.initials: F
authors.lastname: Picard
authors.forename: Florence
authors.initials: F
authors.lastname: Arsac
authors.forename: Marina
authors.initials: M
authors.lastname: Dijos
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.forename: Pierre
authors.initials: P
authors.lastname: Dos Santos
authors.forename: Raymond
authors.initials: R
authors.lastname: Roudaut
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000502:physiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity