Related Experiment Video
Updated: May 6, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart
Georgeann K Groh1, Philip T Levy1, Mark R Holland2
1Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
Insights
Doppler echocardiography (DE) is not accurate for measuring right heart pressure in children with elevated pressures. Right heart catheterization (RHC) remains the gold standard for assessing pediatric right ventricular hypertension.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging
- Hemodynamics
Background:
- Doppler echocardiography (DE) is commonly used to estimate right heart pressure in children, serving as a non-invasive alternative to right heart catheterization (RHC).
- Prospective validation of DE accuracy for assessing right ventricular pressure in pediatric populations is lacking.
- The study addresses the need to evaluate DE's reliability in pediatric patients with varying degrees of right heart pressure.
Purpose of the Study:
- To prospectively evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in children.
- To determine if the severity of RV hypertension influences the accuracy of DE in assessing right heart pressure.
Main Methods:
- Simultaneous DE and RHC were performed in 80 children (0-17.9 years) with two-ventricle physiology.
- The pressure gradient between the RV and right atrium was measured by RHC and estimated by DE using tricuspid regurgitation.
- Patients were stratified into groups based on RHC-measured RV systolic pressure (RVSP) relative to systemic systolic blood pressure (SBP).
Main Results:
- A reasonable correlation was observed between DE and RHC across all groups.
- However, agreement between the two methods significantly decreased as RVSP/SBP increased.
- DE demonstrated higher inaccuracy rates in groups with elevated RVSP (24% and 33%) compared to those with lower pressures (2% and 2%).
Conclusions:
- DE inaccurately estimates RV pressure in pediatric patients with elevated right heart pressures.
- The accuracy of DE diminishes with increasing severity of RV hypertension.
- DE should not be used as the sole method for assessing right heart hemodynamics in children with RV hypertension.
Background:
Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objectives of this study were to evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in pediatric patients and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure.
Methods:
Eighty children (age range, 0-17.9 years; median age, 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and the right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid regurgitation. Patients were then grouped on the basis of RHC-measured RV systolic pressure (RVSP): group 1 (n = 43), with RVSP < 1/2 systemic systolic blood pressure (SBP); group 2 (n = 37), with RVSP ≥ 1/2 SBP; group 3 (n = 56), with RVSP < 2/3 SBP; and group 4 (n = 24), with RVSP ≥ 2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10 mm Hg.
Results:
Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in one of 43 patients in group 1 (2%) versus nine of 37 in group 2 (24%) and was inaccurate in one of 56 patients in group 3 (2%) versus eight of 24 in group 4 (33%). Overestimation and underestimation occurred equally in all groups.
Conclusion:
DE inaccurately estimates RV pressure in children with elevated right heart pressure. It should not be relied on as the sole method of assessing right heart hemodynamics in children with RV hypertension.
Related Concept Videos
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:21Cardiac Catheterization II: Right Heart Catheterization
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...