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Estimating pulmonary artery pressures by echocardiography in patients with emphysema

¹ Division of Pulmonary and Critical Care, Emory University, Atlanta, GA, ² Division of Pulmonary and Critical Care, Temple University School of Medicine, and ³ Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, PA, ⁴ Division of Pulmonary and Critical Care, Johns Hopkins University, and, ⁶ Division of Pulmonary and Critical Care, University of Maryland, Baltimore, MD, and ⁵ Division of Pulmonary, Allergy, and Critical Care, Cleveland Clinic, Cleveland, OH, USA.

CORRESPONDENCE: H. E. Fessler, 1830 Monument St., 5th floor, Baltimore, MD 21287, USA. Fax: 1 4109550036. E-mail: hfessler{at}jhmi.edu

Keywords: Echocardiography, emphysema, lung volume reduction surgery, pulmonary hypertension

Received: March 19, 2007
Accepted July 12, 2007

In patients with emphysema being evaluated for lung volume reduction surgery, Doppler echocardiography has been used to screen for pulmonary hypertension as an indicator of increased peri-operative risk.

To determine the accuracy of this test, the present authors compared the results of right heart catheterisations and Doppler echocardiograms in 163 patients participating in the cardiovascular substudy of the National Emphysema Treatment Trial. Substudy patients had both catheterisation and Doppler echocardiography performed before and after randomisation.

In 74 paired catheterisations and echocardiograms carried out on 63 patients, the mean values of invasively measured pulmonary artery systolic pressures and the estimated right ventricular systolic pressures were similar. However, using the World Health Organization's definitions of pulmonary hypertension, echocardiography had a sensitivity of 60%, specificity of 74%, positive predictive value of 68% and a negative predictive value of 67% compared with the invasive measurement. Bland–Altman analysis revealed a bias of 0.37 kPa with 95% limits of agreement from -2.5–3.2 kPa.

In patients with severe emphysema, echocardiographic estimates of pulmonary artery pressures correlate very weakly with right heart catheterisations, and the test characteristics (e.g. sensitivity, specificity, etc.) of echocardiographic assessments are poor.

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