Estimating pulmonary artery pressures by echocardiography in patients with emphysema

¹ Division of Pulmonary & Critical Care, Emory University, Atlanta, Georgia
² Division of Pulmonary & Critical Care, Temple University School of Medicine, Philadelphia, Pennsylvania
³ Division of Pulmonary & Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
⁴ Division of Pulmonary & Critical Care, Johns Hopkins University, Baltimore, Maryland
⁵ Division of Pulmonary, Allergy, & Critical Care, Cleveland Clinic, Cleveland, Ohio
⁶ Division of Pulmonary & Critical Care, University of Maryland, Baltimore, Maryland
⁷ Appendix 1

^* To whom correspondence should be addressed. E-mail: hfessler{at}jhmi.edu.

	Abstract

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, we compared results of right heart catheterizations and Doppler echocardiograms in 163 patients participating in the cardiovascular substudy of the National Emphysema Treatment Trial. Substudy patients had both catheterization and Doppler echocardiography performed before and after randomization.

In 74 paired catheterizations and echocardiograms done 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%, a specificity of 74%, a positive predictive value of 68%, and a negative predictive value of 67% compared to the invasive measurement. Bland-Altman analysis revealed a bias of 2.81 mmHg with 95% limits of agreement from -18.7 to 24.3 mmHg.

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

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