Clinical lung and heart/lung transplantation
Pulmonary artery systolic pressures estimated by echocardiogram vs cardiac catheterization in patients awaiting lung transplantation

https://doi.org/10.1016/S1053-2498(01)00274-1Get rights and content

Abstract

Background: At many lung transplant centers, right heart catheterization and transthoracic echocardiogram are part of the routine pre-transplant evaluation to measure pulmonary pressures. Because decisions regarding single vs bilateral lung transplant procedures and the need for cardiopulmonary bypass are often made based on pulmonary artery systolic pressures, we sought to examine the relationship between estimated and measured pulmonary artery systolic pressures using echocardiogram and catheterization, respectively.

Methods: We retrospectively reviewed all patients in our program who had measured pulmonary hypertension (n = 57). Patients with both echocardiogram-estimated and catheterization-measured pulmonary artery systolic pressures performed within 2 weeks of each other were included (n = 19). We analyzed results for correlation and linear regression in the entire group and in the patients with primary pulmonary hypertension (n = 8) and pulmonary fibrosis (n = 8).

Results: In patients with primary pulmonary hypertension, pulmonary artery systolic pressure was 94 ± 27 and 95 ± 15 mm Hg by echocardiogram and catheterization, respectively, with r2 = 0.11; in patients with pulmonary fibrosis, 57 ± 23 and 58 ± 12 mm Hg with r2 = 0.22; and in the whole group, 76 ± 29 and 75 ± 23 mm Hg with r2 = 0.50. Thirty-two additional patients had mean pulmonary artery systolic pressure = 48 ± 16 mm Hg by catheterization but either had no evidence of tricuspid regurgitation by echocardiogram (n = 22) or the pulmonary artery systolic pressure could not be measured (n = 10).

Conclusions: In patients with pulmonary hypertension awaiting transplant, pulmonary artery systolic pressures estimated by echocardiogram correspond but do not serve as an accurate predictive model of pulmonary artery systolic pressures measured by catheterization. Technical limitations of the echocardiogram in this patient population often preclude estimating pulmonary artery systolic pressure.

Section snippets

Patient selection

At the time of the study, 119 patients with end-stage vascular or parenchymal pulmonary disease were transplanted or on the waiting list in our lung transplantation program. Recipient criteria and surgical techniques have been previously described.14 All patients received right heart catheterization and transthoracic Doppler echocardiography as part of the pre-transplant evaluation.

Patients with PH as assessed by right heart catheterization who had a Doppler echocardiographic study performed

Results

We reviewed the charts of 119 consecutive patients listed or transplanted for end-stage vascular and parenchymal lung disease by May 15, 1996. This group comprised 29 patients with pulmonary fibrosis (PF); 37 patients with tobacco-related chronic obstructive pulmonary disease (COPD); 29 patients with α1-antitrypsin deficiency-related COPD; 10 patients with primary pulmonary hypertension (PPH); 7 patients with sarcoidosis; 2 patients with scleroderma; and 1 patient each with rheumatoid

Discussion

Using echocardiogram to calculate PAS by measuring the regurgitant jet across the tricuspid valve has been extensively described; however, in these series only 5% to 14% of the patients had vascular or parenchymal lung disease.10, 11, 18 Our group previously described the use of echocardiogram to evaluate the right ventricular structure and function before and after lung transplantation.17 In the initial series, the echocardiogram could not estimate the PAS pressure in 38% of the patients with

Acknowledgements

We want to thank Michael F. Luther, MS, for his help in the statistical analysis of the data.

References (29)

Cited by (74)

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