title: Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in adult atrial septal defect patients with pulmonary arterial hypertension.
abstract: BACKGROUND
  While echocardiography has been a pivotal screening test in pulmonary arterial hypertension (PAH), the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures (PAPs). This study sought to evaluate the accuracy of Doppler echocardiography (DE) for estimating PAPs in adult atrial septal defect (ASD) patients with PAH.
  
  
  METHODS
  A prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization (RHC) in adult ASD patients with PAH who underwent simultaneous DE and RHC. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs.
  
  
  RESULTS
  Two hundred and fifty-seven patients were included in the study. A significant overestimation of the systolic pulmonary arterial pressure (sPAP) and mean pulmonary artery pressure (mPAP) was reported by echocardiography compared with those by catheterization ((81.8 ± 26.9) mmHg vs. (72.9 ± 26.9) mmHg, P < 0.01; (51.9 ± 16.4) mmHg vs. (41.4 ± 17.2) mmHg, P < 0.01, respectively). Twenty-one percent (55/257) of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test. Using Bland-Altman analytic methods, the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95% limits of agreement ranging from -24.4 to 42.6 mmHg. For mPAP measurement, the bias was 10.5 mmHg with 95% limits of agreement ranging from -12.4 to 33.4 mmHg. On multiple linear regression analysis, age, gender, body surface area, ASDs' diameter, PVR, diastolic blood pressure, and echocardiographic assessment of right atrial pressure (RAP) explained 68.8% of the total variability in the model (r(2) = 0.688, P < 0.01).
  
  
  CONCLUSIONS
  Inaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age, gender, body surface area, ASDs' diameter, pulmonary vascular resistance, diastolic blood pressure and echocardiographic estimation of RAP.
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Caojin
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Xinsheng
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Yigao
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Jimei
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Jiyan
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China.
authors.forename: Shulin
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Academy of Medical Sciences & Guangdong Cardiovascular Institute, Guangzhou, Guangdong 510100, China. Email: zhuangjian5413@tom.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhuang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology*; D055815:Young Adult