Abstract
BackgroundThe validity of Doppler echocardiographic (DE) measurement of systolic pulmonary artery pressure (sPAP) has been questioned. Recent studies suggest that mean pulmonary artery pressure (mPAP) might reflect more accurately the invasive pressures.Methodology/Principal Findings241 patients were prospectively studied to evaluate the diagnostic accuracy of mPAP for the diagnosis of PH. Right heart catheterization (RHC) and DE were performed in 164 patients mainly for preoperative evaluation of heart valve dysfunction. The correlation between DE and RHC was better when mPAP (r = 0.93) and not sPAP (r = 0.81) was assessed. Bland-Altman analysis revealed a smaller variation of mPAP than sPAP. The following ROC analysis identified that a mPAP≥25.5 mmHg is useful for the diagnosis of PH. This value was validated in an independent cohort of patients (n = 50) with the suspicion of chronic-thromboembolic pulmonary hypertension. The calculated diagnostic accuracy was 98%, based on excellent sensitivity of 98% and specificity of 100%. The corresponding positive and negative predictive values were 100%, respectively 88%.ConclusionmPAP has been found to be highly accurate for the initial diagnosis of PH. A cut-off value of 25.5 mmHg might be helpful to avoid unnecessary RHC and select patients in whom RHC might be beneficial.
Highlights
Pulmonary hypertension (PH) is associated with restricted flow through the pulmonary circulation, increased pulmonary vascular resistance and right heart failure [1]
Conclusion: mean pulmonary artery pressure (mPAP) has been found to be highly accurate for the initial diagnosis of PH
Baseline characteristics 191 consecutive patients with an indication for right heart catheterization (RHC) were eligible for the study. 7 patients refused to participate in the study, Table 1
Summary
Pulmonary hypertension (PH) is associated with restricted flow through the pulmonary circulation, increased pulmonary vascular resistance and right heart failure [1]. PH has been defined as an elevation of mean pulmonary artery pressure (mPAP)$25 mmHg in right heart catheterization (RHC) [1,4]. The Doppler echocardiogram (DE) can simultaneously provide an estimate of right ventricular systolic pressure (RVSP), functional and morphologic cardiac sequelae of PH, and identification of possible cardiac causes of PH or the presented clinical symptoms. The need for further invasive diagnostics is often triggered by the DE assessment of the peak systolic PAP (sPAP). In the present study we aimed to determine whether echocardiographic assessment of mPAP is more accurate than sPAP for initial diagnosis of PH and estimation of real pulmonary artery pressure. The validity of Doppler echocardiographic (DE) measurement of systolic pulmonary artery pressure (sPAP) has been questioned. Recent studies suggest that mean pulmonary artery pressure (mPAP) might reflect more accurately the invasive pressures
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