Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension
Open Access
- 19 January 2020
- journal article
- research article
- Published by MDPI AG in Diagnostics
- Vol. 10 (1), 49
- https://doi.org/10.3390/diagnostics10010049
Abstract
Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic PASP deterioration with 59% sensitivity, 85% specificity, and 63/83% positive/negative predictive value, respectively. In multivariate analysis, successful echocardiographic prediction correlated only with higher PVR in previous catheterization (p = 0.05, OR = 1.235). Notably, in patients having baseline PVR > 5.45 WU, echocardiography had both sensitivity and positive predictive values of 73%, and both specificity and negative predictive value of 91% for detecting hemodynamic PASP deterioration. In selected patients with CTD-PAH echocardiography can predict PASP deterioration with high specificity and negative predictive value. Additional prospective studies are needed to confirm that better patient selection can increase the ability of standard echocardiography to replace repeat catheterization.This publication has 26 references indexed in Scilit:
- The Diagnostic Accuracy of Doppler Echocardiography in Assessment of Pulmonary Artery Systolic Pressure: A Meta‐AnalysisEchocardiography, 2012
- Pulmonary hypertension in systemic sclerosis and systemic lupus erythematosusEuropean Respiratory Review, 2011
- CorrectionHeart, 2011
- Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysisHeart, 2011
- REVEAL Registry: Correlation of Right Heart Catheterization and Echocardiography in Patients With Pulmonary Arterial HypertensionCongestive Heart Failure, 2011
- Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of EchocardiographyJournal of the American Society of Echocardiography, 2010
- Comparison of Baseline Characteristics and Survival Between Patients With Idiopathic and Connective Tissue Disease–related Pulmonary Arterial HypertensionThe Journal of Heart and Lung Transplantation, 2009
- Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary HypertensionAmerican Journal of Respiratory and Critical Care Medicine, 2009
- Noninvasive Central Venous Pressure Measurement by Controlled Compression Sonography at the ForearmJournal of the American College of Cardiology, 2007
- Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosisRheumatology, 1997