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Correlation Between Doppler Echocardiography and Right Heart Catheterization Derived Pulmonary Artery Pressures:
Ikram Ahmed1, Muhammad Masudul Hassan Nuri1, Ahmad Nasiruddin Zakariyya1
1Department of Cardiology, Tahir Heart Institute, Chenab Nagar, District Chiniot.
Insights
Doppler echocardiography (DE) can overestimate pulmonary artery pressures compared to right heart catheterization (RHC). While adjusting for right atrial pressure minimally improves accuracy, DE often overestimates these critical cardiac measurements.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Pulmonary Hypertension
Background:
- Accurate measurement of pulmonary artery pressures is crucial for diagnosing and managing cardiovascular conditions.
- Right heart catheterization (RHC) is the gold standard, but Doppler echocardiography (DE) is a non-invasive alternative.
- The correlation between DE and RHC derived pressures, and the influence of right atrial (RA) pressure, require further evaluation.
Purpose of the Study:
- To evaluate the correlation between DE and RHC derived pulmonary artery pressures.
- To assess the impact of right atrial (RA) pressures on this correlation.
- To determine the diagnostic accuracy of DE in predicting pulmonary hypertension.
Main Methods:
- A cross-sectional analytical study involving 51 patients undergoing RHC.
- Correlation analysis using Pearson correlation coefficient and Bland-Altman method for DE derived right ventricular systolic pressure (RVSP) and RHC derived systolic pulmonary artery pressures (sPAP).
- Receiver operating characteristic (ROC) curve analysis to identify the optimal RVSP cut-off for pulmonary hypertension detection, with and without RA pressure adjustment.
Main Results:
- A moderate correlation (r=0.72) was found between RVSP and sPAP, with a bias of +4.43 mmHg.
- The best RVSP cut-off for predicting pulmonary hypertension was >52 mmHg (75% accuracy, 81% sensitivity, 69% specificity).
- Adjusting for RA pressure showed minimal improvement in correlation (r=0.75) and diagnostic accuracy (79%).
Conclusions:
- Doppler echocardiography frequently overestimates pulmonary artery pressures when compared to RHC.
- While incorporating accurate RA pressure can slightly enhance the correlation, its overall impact on diagnostic accuracy is limited.
- DE remains a valuable screening tool, but its overestimation potential should be considered in clinical decision-making.
Objective:
To evaluate the correlation between Doppler echocardiography (DE) and right heart catheterization (RHC) derived pulmonary artery pressures and to assess the impact of right atrial (RA) pressures on this correlation.
Study Design:
Cross-sectional analytical study.
Place And Duration Of Study:
Cardiology Department, Tahir Heart Institute, Chenab Nagar, from June 2013 to December 2014.
Methodology:
All patients undergoing RHC were included. Relevant data were collected from hospital database. Continuous variables were expressed as the mean and SD or as the median and interquartile range where the distributions were skewed. Pearson correlation coefficient and Bland-Altman method were used to correlate DE derived right ventricular systolic pressure (RVSP) and RHC derived systolic pulmonary artery pressures (sPAP). Adjusted RVSP was calculated by replacing default value of RA pressure (10 mmHg) with RHC derived mean RA pressure. Receiver operating characteristic curve (ROC) was used to identify the best cut-off value of RVSP in predicting pulmonary hypertension.
Results:
Fifty-one patients completed the study protocol. Mean age of study population was 45.22 ±15.25 years with male to female ratio of 1.47:1. Median error was 13 mmHg (7 to 20). Pearson correlation coefficient (r) between RVSP and sPAP was 0.72. Bland-Altman method of correlation showed bias of +4.43 mmHg with 95% limits of agreement ranging from -34.61 to +43.47. Using ROC curve, the best cut-off value of RVSP was greater than 52 mmHg with accuracy of 75% (sensitivity: 81%, specificity: 69%) in predicting pulmonary hypertension. Adjusted RVSP showed only little improvement in correlation (r = 0.75), adjusted error (13.65 ±13.05) and diagnostic accuracy (79%).
Conclusion:
Doppler echocardiography can frequently overestimate pulmonary artery pressures. Though correctly estimated RA pressure may improve this correlation, yet its contribution is only minimal.
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Preparation of Equipment: