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Published ahead of print on December 12, 2002, doi:10.1164/rccm.200210-1130OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 5, March 2003, 735-740

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Submitted on October 3, 2002
Accepted on December 8, 2002

ECHOCARDIOGRAPHIC ASSESSMENT OF PULMONARY HYPERTENSION IN PATIENTS WITH ADVANCED LUNG DISEASE

Selim M Arcasoy1*, Jason D Christie2, Victor A Ferrari2, Martin St John Sutton2, David A Zisman2, Nancy P Blumenthal2, Alberto Pochettino2, and Robert M Kotloff2

1 Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, New York, NY, USA, 2 Divisions of Pulmonary, Allergy and Critical Care Medicine,Cardiothoracic Surgery and Cardiovascular Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA

* To whom correspondence should be addressed. E-mail: sa2059{at}columbia.edu.

Doppler echocardiography is commonly used to estimate systolic pulmonary artery pressure and diagnose pulmonary hypertension, but data relating to its utility in patients with advanced lung disease are limited. In a cohort study of 374 lung transplant candidates, the performance characteristics of echocardiography compared to right heart catheterization in the determination of systolic pulmonary artery pressure and diagnosis of pulmonary hypertension were investigated. The prevalence of pulmonary hypertension was 25% in the study population. Estimation of systolic pulmonary artery pressure by echocardiography was possible in 166 patients (44%). Correlation between systolic pulmonary artery pressure estimated by echocardiography and measured by cardiac catheterization was good (r=0.69; p<0.0001). However, 52% of pressure estimations were found to be inaccurate (>10 mm Hg difference compared to measured pressure), and 48% of patients were misclassified as having pulmonary hypertension by echocardiography. Sensitivity, specificity, positive and negative predictive values of systolic pulmonary artery pressure estimation for diagnosis of pulmonary hypertension were 85%, 55%, 52 % and 87%, respectively. In conclusion, despite a statistically significant correlation with directly measured values, estimation of systolic pulmonary artery pressure by echocardiography is frequently inaccurate in patients with advanced lung disease and leads to considerable overdiagnosis of pulmonary hypertension.
Key words: Pulmonary hypertension,echocardiography, cardiac catheterization, lung disease




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