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Noninvasive and invasive evaluation of pulmonary arterial pressure in highlanders

¹ Institute of Molecular Biology and Medicine, and ² National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan, ³ Dept of Pathophysiology, Free University of Brussels, Brussels, Belgium, and ⁴ Section of Experimental Medicine and Toxicology, Imperial College London, Hammersmith Hospital, London, United Kingdom.

CORRESPONDENCE: M. R. Wilkins, Section of Experimental Medicine and Toxicology, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK. Fax: 44 2083832066. E-mail: m.wilkins{at}imperial.ac.uk

Keywords: ECG, echocardiography, high-altitude pulmonary hypertension, pulmonary circulation, right heart catheterisation

Received: November 22, 2005
Accepted October 12, 2006

The purpose of the present study was to evaluate Doppler echocardiography for the detection of pulmonary hypertension in high-altitude inhabitants.

In total, 60 (55 male) patients aged 18–71 yrs were recruited from an ECG screening programme applied to 1,430 inhabitants living at an altitude of 2,500–3,600 m in Kyrgyzstan. Of these, 44 met ECG criteria for right ventricular hypertrophy. All underwent Doppler echocardiography followed by a cardiac catheterisation within 7 days of arrival in Bishkek (Kyrgyzstan; altitude 760 m). Pulmonary flow acceleration time and the maximum velocity of tricuspid regurgitation were measured.

Sufficient quality tricuspid regurgitant jets were recovered in only 28% of the patients. Therefore, pulmonary artery pressure was estimated from the pulmonary flow acceleration time, which was recovered in 100% of the patients. It was found that 37 (62%) of the patients had pulmonary hypertension on echocardiography. Pulmonary hypertension was confirmed in 29 patients on catheterisation. Pulmonary hypertension was detected with 70% sensitivity and 88% specificity by echocardiography, as compared to 59% sensitivity and 81 % specificity by ECG. The correlation coefficient between echocardiography and catheterisation studies was r² = 0.78.

It is concluded that a combination of ECG and echocardiography may be useful for screening high-altitude pulmonary hypertension.

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