ABSTRACT
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
ABSTRACT
Introduction: Congenital anomalies of the coronary arteries occur in 0.2% to 1.2% of the general population1. The incidence of various coronary anomalies and associated clinical, angiographic and hemodynamic findings have been cited in several internationally published clinical series4-8. To compare our experience with previously reported studies, we have reviewed clinical and angiographic findings for 50 adult patients with coronary artery anomalies. We surveyed the records of 5050 consecutive adult patients who had undergone coronary angiography. Armed Forces Institute of Cardiology and National Institute of Heart Disease [AFIC/NIHD] Rawalpindi. 1[st] Jan 2004 and 30th April 2005, and identified 50 adults with various coronary artery anomalies. 5050 reports were reviewed and 50 [0.9%] coronary artery anomalies were identified in 50 patients. Different anomalies identified are; both coronary arteries from right sinus of Valsalva [RSV]-[n = 1], both coronary arteries arising from the left coronary sinus [n = 4], single coronary arteries [n = 2], LCx from RSV/RCA [n=6], anterior descending artery arising from the right coronary sinus [n = 1], coronary artery fistulae [n = 4], separated origin of anterior descending and left circumflex coronary arteries [n = 25], and separate origin of conus/ RV branch [n = 7]. The initial course was retroaortic in all the circumflex arteries, interarterial in the right coronaries, and anterior in the anterior descending arteries. We conclude that adult congenital anomalies of the coronary arteries are not uncommon finding in a tertiary care cardiac center. Separate origin of LAD and LCx from LSV and left circumflex coronary artery arising from RSV/RCA are the most frequently diagnosed anomalies