Abstract 18650: Right Ventricular Dysfunction Compromises Accuracy of Echocardiographic Diagnosis of Pulmonary Hypertension in Heart Failure
Introduction: Determination of severity of pulmonary hypertension is critical in advanced heart failure (HF). Echocardiography (ECHO) is commonly used to estimate pulmonary artery systolic pressure (PASP). Accuracy of ECHO in patients with severe left ventricular (LV) systolic dysfunction which is often accompanied by right ventricular (RV) dysfunction is unknown.
Objective: To evaluate accuracy of ECHO-estimated PASP in HF with severe LV systolic dysfunction.
Methods: We analyzed a limited access dataset from the ESCAPE trial provided by NHLBI. Patients enrolled in this trial had LV ejection fraction >/=30% and <30%, respectively. Pearson's correlation coefficient, sensitivity, and specificity were calculated.
Results: PASP measured by Swan-Ganz and estimated by ECHO correlated moderately. Swan- Ganz data obtained at baseline correlated best with ECHO at baseline (decompensation). Swan-Ganz data obtained on the next day (subcomplensation) and the last day (compensation) correlated best with ECHO data at 3 month follow-up. At all times, correlation was better for preserved than for depressed RV function (Table). Sensitivity and specificity of ECHO for moderate and severe pulmonary hypertension (PASP >/= 45 mm Hg) were 0.6 and 0.6 in decompensation, 0.5 and 0.6 in subcompensation, and 0.3 and 0.9 in compensation. For severe pulmonary hypertension (PASP >/= 60 mm Hg), they were 0.4 and 0.9, 0.2 and 1, and 0.4 and 0.9, respectively.
Conclusion: Echocardiographic estimation of pulmonary hypertension in patients with advanced systolic HF is inaccurate and cannot replace direct measurement. Accuracy is better if right ventricular systolic function is preserved.
- © 2010 by American Heart Association, Inc.