
Reappraisal of the reliability of Doppler echocardiographic estimations for mean pulmonary artery pressure in patients with pulmonary hypertension: a study from a tertiary centre comparing four formulae
Author(s) -
Kaymaz Cihangir,
Akbal Ozgur Yasar,
Hakgor Aykun,
Tokgoz Hacer Ceren,
Tanboga Ibrahim Halil,
Aktemur Tugba,
Turkday Sevim,
Tanyeri Seda,
Poci Nertila,
Keskin Berhan,
Dogan Cem,
Bayram Zubeyde,
Acar Rezzan Deniz,
Ozdemir Nihal
Publication year - 2018
Publication title -
pulmonary circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.791
H-Index - 40
ISSN - 2045-8940
DOI - 10.1177/2045894018762270
Subject(s) - medicine , pulmonary hypertension , concordance , pulmonary artery , cardiology , doppler echocardiography , blood pressure , surgery , diastole
Different Doppler echocardiography (DE) models have been proposed for estimation of mean pulmonary arterial pressures (PAMP) from tricuspid regurgitation (TR) jet velocity. We aimed to compare four TR‐derived DE models in predicting the PAMP measured by right heart catheterization (RHC) in different groups of precapillary pulmonary hypertension (PH). A total of 287 patients with hemodynamically pre‐capillary PH were enrolled (mean age = 51 ± 17.4 years, 59.9% female). All patients underwent DE before RHC (< 3 h) and four formulae (F) were used for TR‐derived PAMP estimation (PAMP‐DE). These were as follows: F1 = Chemla (0.61 × systolic pulmonary artery pressure [PASP] + 2); F2 = Friedberg (0.69 × PASP − 0.22), F3 = Aduen (0.70 × PASP); and F4 = Bech‐Hanssen (0.65 × PASP − 1.2). The PASP and PAMP (mmHg) measured by RHC were 89.1 ± 30.4 and 55.8 ± 20.8, respectively. In the overall PH group, DE estimates for PASP (r = 0.59, P = 0.001) and PAMP (r = 0.56, P = 0.001 for all) showed significant correlations with corresponding RHC measures. Concordance was noted between Chemla and Bech‐Hanssen, and Aduen and Bech‐Hanssen. The Bland–Altman plot showed that Chemla and Bech‐Hanssen overestimated and Friedberg and Aduen underestimated PAMP‐RHC measures. Paired‐t test showed significant systematic biases for Aduen and Bech‐Hanssen while Passing‐Bablok non‐parametric analysis revealed significant systematic biases all four PAMP‐DE estimates. There was poor agreement between PAMP‐RHC measures and PAMP‐DE deciles (Kappa values were 0.112, 0.097, 0.095, and 0.121, respectively). This study showed a poor agreement between PAMP‐DE estimates by four TR‐derived formulae and PAMP‐RHC in patients with PH, regardless of the etiology. However, these results can not be fully extrapolated to a normal population and did not address the reliability of DE estimates for PH screening procedures.