Echocardiography accurately predicts pulmonary hypertension in patients with advanced lung disease

Excerpt

Pulmonary hypertension (PH) may be observed in many different conditions, including advanced heart or lung disease [1]. PH is defined as elevation of the mean pulmonary arterial pressure (mPAP) ≥25 mmHg, measured by right heart catheterization (RHC). Since procedure-related risks and costs are not negligible, RHC is not routinely performed in patients with advanced lung disease during initial assessment and follow-up. Echocardiography is commonly used as screening tool for the presence of PH, but might be of limited diagnostic value, in particular in patients with lung disease [2]. Empirical formulas were proposed to calculate the mPAP starting from systolic pulmonary arterial pressure (sPAP) as assessed by echocardiography [3, 4]. It has been suggested that both the Chemla formula (mPAP = sPAP × 0.61 + 2 mmHg) and the Syyed formula (mPAP = sPAP × 0.65 + 0.55 mmHg) might accurately estimate the mPAP [5]. The aim of our study was to assess the accuracy of these echocardiography-based formulas to estimate the invasively measured mPAP in a cohort of patients with advanced lung disease. Estimation of sPAP by echocardiography was performed according to current recommendation by adding to the right ventricular/right atrial pressure gradient (based on Doppler-measured tricuspid regurgitation velocity) the estimated right atrial pressure (based on inferior vena cava diameter and collapsibility). A total of 96 consecutive patients undergoing lung transplant evaluation between 03/2000 and 10/2015 were included. Data from RHC and echocardiography performed the same day were available for the whole cohort. …