Pulmonary artery systolic pressures estimated by echocardiogram vs measured by cardiac catheterization in patients undergoing lung transplantation

Arturo Homma, S. M. Levine, A. Anzueto, J. I. Peters, I. Susanto, E. Sako, C. L. Bryan

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Abstract

Purpose: At many lung transplant (LT) centers, right heart catheterization (RHC) and transthoracic echocardiogram (TTE) are part of the pretransplant workup to measure pulmonary artery pressures and to detect intracardiac shunts. In patients with pulmonary hypertension (PH), TTE can estimate the pulmonary artery systolic (PAS) pressures based on the tricuspid regurgitant fraction. Since decisions regarding single vs. bilateral LT procedures and the need for cardiopulmonary bypass (CPB) are often made on PA pressures, we examined the correlation between estimated and measured PAS pressures by TTE and RHC respectively. We hypothesize that there is enough variation between the estimated and measured PAS pressures to support continued RHC as part of the pre-LT evaluation. Methods: We reviewed all patients with pulmonary hypertension (PAM >25 mmHg) listed or transplanted at our LT program (n=57). Patients with both TTE estimated PAS pressure and RHC measured PAS pressure performed within 2 weeks of each other were analyzed for correlation and linear regression (n=19). An additional 32 patients had PAS=48±3 mmHg (mean±SEM) but either had no evidence of tricuspid regurgitation by TTE (n=22) or PAS was unable to be measured (n=10). Six patients had an incomplete data base for evaluation. Results: DX PPH PF Total † N 8 8 19 PAS-TTE * 94±10 58±8 77±7 (67-140) (30-102) (30-102) PAS-RHC * 96±6 58±4 75±5 (73-123) (32-72) (32-123) Correlation p=0.22 p=0.14 p=0.0004 Regression R2=0.11 R2=0.22 R2=0.50 * mean±SEM (range) in mmHg. † includes COPD n=1; scleroderma n=2; PPH=primary pulmonary hypertension; PF=pulmonary fibrosisi Conclusions: PAS pressures estimated by TTE correlate, but do not serve as an accurate predictive model of PAS pressures measured by RHC. TTE is even less accurate in patients with PPH or PF. Technical limitations of TTE in this patient population often preclude an estimate of PAS. Clinical Implications: In LT programs where a decision to perform SLT or BLT procedures and institute CPB is based on PA pressures, we continue to recommend RHC as part of the pre-LT evaluation.

Original languageEnglish (US)
Pages (from-to)38S
JournalChest
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1 1996

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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