Comparison of transthoracic echocardiography and right heart catheterization for assessing pulmonary arterial pressure in patients with congenital or valvular heart defects

ABSTRACT

Although right heart catheterization [RHC] has acceptable accuracy for the measurement of pulmonary arterial pressure [PAP], significant risks and cost issues are worrisome. Thus, a non-invasive technique such as echocardiography for assessing PAP would clearly be of great clinical value. We aimed to compare estimated systolic PAP [SPAP] by echocardiogram with the actual RHC measurements in the two groups of congenital and valvular heart diseases [CHD and VHD, respectively], in whom pulmonary hypertension [PHT] was clinically suspected. A total of 103 consecutive patients with confirmed CHD or VHD referred to our center between January and December 2009 were studied. Participants underwent transthoracic echocardiogaphy and RHC within 4 hours of each other. The mean SPAP in the CHD group was no different measured by RHC or echo [46.49 +/- 29.04 vs. 46.45 +/- 23 mmHg, p = 0.541]. The mean SPAP in the VHD group measured by RHC was significantly higher than that measured by echo [48.70 +/- 14.50 vs. 44.90 +/- 11.0 mmHg, p = 0.041]. Fifty-one [49.5%] patients were found to have PHT at RHC. Echocardiography correctly identified 48 of these patients [sensitivity=94.1%]. Nineteen of the 52 patients without PHT on RHC were correctly identified by echocardiography [specificity= 36.5%]. The positive and negative predictive values for echocardiography in assessing the presence or absence of PHT were 59.3% and 86.4%, respectively. Integration of hemodynamic data with the eho examination can appropriately provide comprehensive assessment of PHT with high sensitivity in individual patients with congenital or valvular heart defects