Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae

Kaymaz C., Akbal O. Y., Hakgor A., Tokgoz H. C., Tanboga I. H., Aktemur T., ...Daha Fazla

PULMONARY CIRCULATION, cilt.8, sa.2, 2018 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 8 Sayı: 2
  • Basım Tarihi: 2018
  • Doi Numarası: 10.1177/2045894018762270
  • Dergi Adı: PULMONARY CIRCULATION
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Anahtar Kelimeler: pulmonary hypertension, pulmonary artery pressure, echocardiography, right heart catheterization, agreement, EUROPEAN ASSOCIATION, AMERICAN SOCIETY, RIGHT HEART, ADULTS, CATHETERIZATION, GUIDELINES, ACCURACY, DISEASE
  • Atatürk Üniversitesi Adresli: Evet

Özet

Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR-derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre-capillary PH were enrolled (mean age=51 +/- 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3h) and four formulae (F) were used for TR-derived PAMP estimation (PAMP-DE). These were as follows: F1=Chemla (0.61xsystolic pulmonary artery pressure [PASP]+2); F2=Friedberg (0.69xPASP-0.22), F3=Aduen (0.70xPASP); and F4=Bech-Hanssen (0.65xPASP-1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 +/- 30.4 and 55.8 +/- 20.8, respectively. In the overall PH group, DE estimates for PASP (r=0.59, P=0.001) and PAMP (r=0.56, P=0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech-Hanssen, and Aduen and Bech-Hanssen. The Bland-Altman plot showed that Chemla and Bech-Hanssen overestimated and Friedberg and Aduen underestimated PAMP-RHC measures. Paired-t test showed significant systematic biases for Aduen and Bech-Hanssen while Passing-Bablok non-parametric analysis revealed significant systematic biases all four PAMP-DE estimates. There was poor agreement between PAMP-RHC measures and PAMP-DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP-DE estimates by four TR-derived formulae and PAMP-RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.