Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization

K Skalsky,P Codner,L Perl,A Samara,T Abu,D Hadsai,R Hirsh,R Kornowski,A Levi,M R Kramer,D Rosengarten,T Bental,H Vaknin-Assa

doi:10.1093/eurheartj/ehab724.2794

K Skalsky, P Codner + Show 11 more

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https://doi.org/10.1093/eurheartj/ehab724.2794

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Abstract

Abstract Background Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population. Methods From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH. Results Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p&lt;0.01). The accuracy of the echocardiographic estimation of PASP was poor with &gt;10 mmHg differences between the two values in 79.9% of the patients. Conclusions In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy. Funding Acknowledgement Type of funding sources: None.

Highlights

Lung transplant (LT) is a life-saving procedure for advanced stage of lung disease[1]
From a retrospective registry of 393 LT candidates undergoing Right heart catheterization (RHC) and echocardiography during 2015-2019, patients were assessed for the presence of pulmonary hypertension (PH), defined as mean pulmonary artery pressure above 20 mmHg, according to two methods – echocardiography and RHC
The primary outcome was the correlation between the pulmonary artery systolic pressure (PASP) estimated by echocardiography to that measured by RHC

Summary

Introduction

Lung transplant (LT) is a life-saving procedure for advanced stage of lung disease[1]. Pulmonary hypertension (PH), defined as mean pulmonary artery pressure (mPAP) above 20 mmHg2, is common in those patients and is important to recognize prior to transplant. Right heart catheterization (RHC) is the gold standard for measuring pulmonary artery systolic pressure (PASP), mean pulmonary artery pressure (mPAP) and other cardiac hemodynamic parameters[9,10,11]. When performed in an experienced center, RHC in patients with pulmonary arterial hypertension (PAH) is associated with 1.1% morbidity and 0.055% mortality complication rate[12]. Echocardiography is an acceptable non-invasive alternative for measuring PASP. It provides an estimation of PASP, by adding the regurgitant flow on continuous-wave Doppler over the tricuspid valve to the estimated right atrial pressure (RAP)[10,11,13,14]

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