title: Accuracy and precision of echocardiography versus right heart catheterization for the assessment of pulmonary hypertension.
abstract: BACKGROUND
  Echocardiographic studies have contributed to progress in the understanding of the pathophysiology of the pulmonary circulation and have been shown to be useful for screening for and prognostication of pulmonary hypertension, but are considered unreliable for the diagnosis of pulmonary hypertension. We explored this apparent paradox with rigorous Bland and Altman analysis of the accuracy and the precision of measurements collected in a large patient population.
  
  
  METHODS
  A total of 161 patients referred for a suspicion of pulmonary hypertension were prospectively evaluated by a Doppler echocardiography performed by dedicated cardiologists within 1 h of an indicated right heart catheterization.
  
  
  RESULTS
  Nine of the patients (6%) were excluded due to an insufficient signal quality. Of the remaining 152 patients, 10 (7%) had no pulmonary hypertension and most others had either pulmonary arterial hypertension (36%) or pulmonary venous hypertension (40%) of variable severities. Mean pulmonary artery pressure, left atrial pressure and cardiac output were nearly identical at echocardiography and catheterization, with no bias and tight confidence intervals, respectively ± 3 mm Hg, ± 5 mm Hg and ± 0.3 L/min. However, the ± 2SD limits of agreement were respectively of + 19 and - 18 mm Hg for mean pulmonary artery pressure, + 8 and - 12 mm Hg for left atrial pressure and + 1.8 and - 1.7 L/min for cardiac output.
  
  
  CONCLUSIONS
  Doppler echocardiography allows for accurate measurements of the pulmonary circulation, but with moderate precision, which explains why the procedure is valid for population studies but cannot be used for the individual diagnosis of pulmonary hypertension.
authors.affiliation: Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy. Electronic address: mic.dalto@tin.it.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
authors.forename: Emanuele
authors.initials: E
authors.lastname: Romeo
authors.forename: Paola
authors.initials: P
authors.lastname: Argiento
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.forename: Rebecca
authors.initials: R
authors.lastname: Vanderpool
authors.forename: Anna
authors.initials: A
authors.lastname: Correra
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Berardo
authors.initials: B
authors.lastname: Sarubbi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000592:standards*; D015150:Echocardiography, Doppler / Q000592:standards*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
keywords: Echocardiography; Hemodynamics; Pulmonary hypertension