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Published ahead of print on January 22, 2009, doi:10.1164/rccm.200811-1691OC

Am. J. Respir. Crit. Care Med., Volume 179, Number 7, April 2009, 615-621

A more recent version of this article appeared on April 1, 2009
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Submitted on November 5, 2008
Accepted on January 22, 2009

Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension

Micah R Fisher1, Paul R Forfia2, Elzbieta Chamera3, Traci Housten-Harris1, Hunter C Champion3, Reda E Girgis1, Mary C Corretti3, and Paul M Hassoun4*

1 Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States, 2 Division of Cardiology, Department of Medicine, Johns Hopkins Univeristy, Baltimore, Maryland, United States, 3 Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States, 4 Division of Pulmonary & Critical Care Medicine, Johns Hopkins Univeristy, Baltimore, Maryland, United States

* To whom correspondence should be addressed. E-mail: phassoun{at}jhmi.edu.

Rationale: Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension. However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate. Objectives: Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output. Methods: We conducted a prospective study on patients with various forms of pulmonary hypertension who underwent comprehensive Doppler echocardiography within one hour of a clinically indicated right heart catheterization in order to compare non-invasive hemodynamic estimates to invasively measured values. Measurements and Main Results: A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressures was -0.6 mmHg with 95% limits of agreement ranging from +38.8 to -40.0 mmHg. Doppler echocardiography was inaccurate (defined as being greater than +/-10mmHg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with similar frequency (16 versus 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30±16 vs. +19±11 mmHg; P=0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min. Conclusions: Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for pulmonary hypertension.
Key words: Pulmonary hypertension • Echocardiography • Transthoracic Doppler




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