Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension
Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate. Evaluate the accuracy of Doppler echocardi...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2009-04, Vol.179 (7), p.615-621 |
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| container_title | American journal of respiratory and critical care medicine |
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| creator | Fisher, Micah R Forfia, Paul R Chamera, Elzbieta Housten-Harris, Traci Champion, Hunter C Girgis, Reda E Corretti, Mary C Hassoun, Paul M |
| description | Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate.
Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH. |
| doi_str_mv | 10.1164/rccm.200811-1691OC |
| format | Article |
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Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.200811-1691OC</identifier><identifier>PMID: 19164700</identifier><language>eng</language><publisher>New York, NY: Am Thoracic Soc</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Echocardiography, Doppler - adverse effects ; False Negative Reactions ; False Positive Reactions ; Female ; H. Pulmonary Vascular Disease ; Humans ; Hypertension, Pulmonary - diagnostic imaging ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Prospective Studies ; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases ; Sensitivity and Specificity</subject><ispartof>American journal of respiratory and critical care medicine, 2009-04, Vol.179 (7), p.615-621</ispartof><rights>2009 INIST-CNRS</rights><rights>Copyright American Thoracic Society Apr 1, 2009</rights><rights>Copyright © 2009, American Thoracic Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c637t-c22387521beb798df0b6f23c3124285420d362b187e2ebc6bfcdb7495a2edeff3</citedby><cites>FETCH-LOGICAL-c637t-c22387521beb798df0b6f23c3124285420d362b187e2ebc6bfcdb7495a2edeff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4010,4011,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21332744$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19164700$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fisher, Micah R</creatorcontrib><creatorcontrib>Forfia, Paul R</creatorcontrib><creatorcontrib>Chamera, Elzbieta</creatorcontrib><creatorcontrib>Housten-Harris, Traci</creatorcontrib><creatorcontrib>Champion, Hunter C</creatorcontrib><creatorcontrib>Girgis, Reda E</creatorcontrib><creatorcontrib>Corretti, Mary C</creatorcontrib><creatorcontrib>Hassoun, Paul M</creatorcontrib><title>Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate.
Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Echocardiography, Doppler - adverse effects</subject><subject>False Negative Reactions</subject><subject>False Positive Reactions</subject><subject>Female</subject><subject>H. Pulmonary Vascular Disease</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnostic imaging</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pneumology</subject><subject>Prospective Studies</subject><subject>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. 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Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Echocardiography, Doppler - adverse effects</topic><topic>False Negative Reactions</topic><topic>False Positive Reactions</topic><topic>Female</topic><topic>H. Pulmonary Vascular Disease</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnostic imaging</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pneumology</topic><topic>Prospective Studies</topic><topic>Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases</topic><topic>Sensitivity and Specificity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fisher, Micah R</creatorcontrib><creatorcontrib>Forfia, Paul R</creatorcontrib><creatorcontrib>Chamera, Elzbieta</creatorcontrib><creatorcontrib>Housten-Harris, Traci</creatorcontrib><creatorcontrib>Champion, Hunter C</creatorcontrib><creatorcontrib>Girgis, Reda E</creatorcontrib><creatorcontrib>Corretti, Mary C</creatorcontrib><creatorcontrib>Hassoun, Paul M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fisher, Micah R</au><au>Forfia, Paul R</au><au>Chamera, Elzbieta</au><au>Housten-Harris, Traci</au><au>Champion, Hunter C</au><au>Girgis, Reda E</au><au>Corretti, Mary C</au><au>Hassoun, Paul M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>179</volume><issue>7</issue><spage>615</spage><epage>621</epage><pages>615-621</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Transthoracic Doppler echocardiography is recommended for screening for the presence of pulmonary hypertension (PH). However, some recent studies have suggested that Doppler echocardiographic pulmonary artery pressure estimates may frequently be inaccurate.
Evaluate the accuracy of Doppler echocardiography for estimating pulmonary artery pressure and cardiac output.
We conducted a prospective study on patients with various forms of PH who underwent comprehensive Doppler echocardiography within 1 hour of a clinically indicated right-heart catheterization to compare noninvasive hemodynamic estimates with invasively measured values.
A total of 65 patients completed the study protocol. Using Bland-Altman analytic methods, the bias for the echocardiographic estimates of the pulmonary artery systolic pressure was -0.6 mm Hg with 95% limits of agreement ranging from +38.8 to -40.0 mm Hg. Doppler echocardiography was inaccurate (defined as being greater than +/-10 mm Hg of the invasive measurement) in 48% of cases. Overestimation and underestimation of pulmonary artery systolic pressure by Doppler echocardiography occurred with a similar frequency (16 vs. 15 instances, respectively). The magnitude of pressure underestimation was greater than overestimation (-30 +/- 16 vs. +19 +/- 11 mm Hg; P = 0.03); underestimates by Doppler also led more often to misclassification of the severity of the PH. For cardiac output measurement, the bias was -0.1 L/min with 95% limits of agreement ranging from +2.2 to -2.4 L/min.
Doppler echocardiography may frequently be inaccurate in estimating pulmonary artery pressure and cardiac output in patients being evaluated for PH.</abstract><cop>New York, NY</cop><pub>Am Thoracic Soc</pub><pmid>19164700</pmid><doi>10.1164/rccm.200811-1691OC</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| issn | 1073-449X 1535-4970 |
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| source | MEDLINE; Journals@Ovid Complete; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Echocardiography, Doppler - adverse effects False Negative Reactions False Positive Reactions Female H. Pulmonary Vascular Disease Humans Hypertension, Pulmonary - diagnostic imaging Intensive care medicine Male Medical sciences Middle Aged Pneumology Prospective Studies Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases Sensitivity and Specificity |
| title | Accuracy of Doppler Echocardiography in the Hemodynamic Assessment of Pulmonary Hypertension |
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