title: Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart pressure.
abstract: BACKGROUND
  Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objectives of this study were to evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in pediatric patients and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure.
  
  
  METHODS
  Eighty children (age range, 0-17.9 years; median age, 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and the right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid regurgitation. Patients were then grouped on the basis of RHC-measured RV systolic pressure (RVSP): group 1 (n = 43), with RVSP < 1/2 systemic systolic blood pressure (SBP); group 2 (n = 37), with RVSP ≥ 1/2 SBP; group 3 (n = 56), with RVSP < 2/3 SBP; and group 4 (n = 24), with RVSP ≥ 2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10 mm Hg.
  
  
  RESULTS
  Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in one of 43 patients in group 1 (2%) versus nine of 37 in group 2 (24%) and was inaccurate in one of 56 patients in group 3 (2%) versus eight of 24 in group 4 (33%). Overestimation and underestimation occurred equally in all groups.
  
  
  CONCLUSIONS
  DE inaccurately estimates RV pressure in children with elevated right heart pressure. It should not be relied on as the sole method of assessing right heart hemodynamics in children with RV hypertension.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Georgeann K
authors.initials: GK
authors.lastname: Groh
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Philip T
authors.initials: PT
authors.lastname: Levy
authors.affiliation: Department of Physics, Washington University, St. Louis, Missouri.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Holland
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Murphy
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Sekarski
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Myers
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Diana P
authors.initials: DP
authors.lastname: Hartman
authors.affiliation: St. Louis Children's Hospital, St. Louis, Missouri.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Roiger
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri. Electronic address: singh_g@kids.wustl.edu.
authors.forename: Gautam K
authors.initials: GK
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D001795:Blood Pressure Determination / Q000379:methods* / Q000592:standards*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D061827:Dimensional Measurement Accuracy; D015150:Echocardiography, Doppler; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D007223:Infant; D008297:Male; D019300:Medical Errors; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016278:Ventricular Function, Right / Q000502:physiology; D017725:Ventricular Pressure
keywords: Children; DE; Doppler echocardiography; PASP; Pulmonary artery systolic pressure; RA; RHC; RV; RVSP; Right atrial; Right heart catheterization; Right ventricle; Right ventricular; Right ventricular systolic pressure; SBP; Systolic blood pressure; TR; Tricuspid regurgitation