Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 02/2009; 179(7):615-21. DOI: 10.1164/rccm.200811-1691OC
Source: PubMed


Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate.
Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.

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    • "Variables Females p-value Males Prevalence 49.2% (160) Ns* 50.7% (165) Mean age (year) 29.3 ± 9.6 (8-59) Ns 29.8 ± 9.9 (5-58) Thalassemia minors 60.0% (96) Ns 67.2% (111) Smoking 6.2% (10) < 0.001 21.8% (36) İleus 1.2% (2) < 0.01 3.6% (6) Mortality 3.7% (6) Ns 6.0% (10) *Nonsignificant (p > 0.05). [6] "
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    ABSTRACT: Background: We tried to understand whether or not there is an increased incidence of ileus in patients with sickle cell diseases (SCDs). Methods: All cases with SCDs were taken into the study. Results: The study included 325 patients (160 females). The mean ages were similar in both sexes (29.3 versus 29.8 years in females and males, respectively, p > 0.05). Incidence of ileus was higher in males, significantly (3.6% versus 1.2%, p < 0.01). All of the ileus cases were able to be treated with simple and repeated red blood cell (RBC) transfusions without any surgical procedure. Smoking was higher in males, too (21.8% versus 6.2%, p < 0.001). The mean hematocrit value was also higher in males, significantly (24.4% versus 23.0%, p = 0.016). RBC units transfused, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, and chronic renal disease were all higher in males, too (p < 0.05 for all). On the other hand, although the general mortality, white blood cell and platelet counts of peripheric blood, painful crises per year, rheumatic heart disease, avascular necrosis of bone, cirrhosis, and stroke were all higher in males, the differences were nonsignificant probably due to the small sample sizes of the groups (p > 0.05 for all). Conclusion: Although the relatively young mean ages of the patients with SCDs, the very high incidences of ileus are probably due to the strong atherosclerotic and obstructive natures of the two pathologies, and ileus should be treated with simple and repeated RBC transfusions to restore bowel perfusion in such patients.
    International Journal of Clinical and Experimental Medicine 10/2014; 7(9):2871-6. · 1.28 Impact Factor
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    • "Furthermore, we measured the peak velocity of the tricuspid regurgitant signal by continuous wave doppler and calculated the RVSP with the modified Bernoulli equation, which is believed to reflect systolic PA-pressure in the absence of RV outflow tract obstruction. Theoretically, calculation of mPAP from systolic PA-pressure (PASP) is possible, {mPAP = (0.61×PASP) + 2 mmHg} (23). "
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    ABSTRACT: Pulmonary hypertension (PH) is an important cause of heart failure in chronic obstructive pulmonary disease (COPD). The pro brain natriuretic peptide N-terminal (NT-proBNP) has been suggested as a noninvasive marker to evaluate ventricular function. However, there is no evidence to support the use of NT-proBNP in monitoring the benefits of vasodilators in COPD induced PH. Thus, we used NT-proBNP as a biomarker to evaluate the effect of oral vasodilators on cardiac function in COPD-induced PH. Forty clinically-stable PH patients were enrolled with history of COPD, normal left ventricular ejection-fraction (LVEF), right ventricular systolic pressure (RVSP) > 45 mmHg and baseline blood NT-proBNP levels >100 pg/mL. Patients were randomized into two groups, one group received sildenafil and second group were given amlodipine for two weeks. NT-proBNP and systolic pulmonary arterial pressure (systolic PA-pressure) were measured at the beginning and the end of study. Mean NT-proBNP level in the first group was 1297 ± 912 pg/mL before therapy and 554 ± 5 pg/mL after two weeks drug therapy, respectively. Similarly, in second group NT-proBNP level was 1657 ± 989 pg/mL and 646 ± 5 pg/mL before and after treatment. Amlodipine or sildenafil significantly reduced NT-proBNP levels in COPD-induced PH patients (p < 0.05). Our study shows that amlodipine and sildenafil have a similar effect on NT-proBNP levels. In both groups NT- proBNP levels were significantly reduced after treatment. Therefore, our findings support the potential benefits of treatment with vasodilators in COPD induced PH. Pulmonary hypertension, Chronic obstructive pulmonary disease, NT-proBNP, Amlodipine, Sildenafil
    Iranian journal of pharmaceutical research (IJPR) 03/2014; 13(Suppl):161-8. · 1.07 Impact Factor
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    • "It also provides important information on left heart function. Despite having much greater sensitivity and specificity for PH than the ECG and CXR, the cardiac echo may under- or overestimate the degree of pulmonary artery pressure [31], which is also true for patients with HIV-related PAH [28]. "
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    ABSTRACT: Human immunodeficiency virus- (HIV-) related pulmonary arterial hypertension (PAH) is a rare complication of HIV infection. The pathophysiology of HIV-related PAH is complex, with viral proteins seeming to play the major role. However, other factors, such as coinfection with other microorganisms and HIV-related systemic inflammation, might also contribute. The clinical presentation of HIV-related PAH and diagnosis is similar to other forms of pulmonary hypertension. Both PAH-specific therapies and HAART are important in HIV-related PAH management. Future studies investigating the pathogenesis are needed to discover new therapeutic targets and treatments.
    08/2013; 2013(5). DOI:10.1155/2013/903454
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