Correlation Between Doppler Echocardiography and Right HearCatheterisation-Derived Systolic and Mean Pulmonary Artery Pressures: Determinants of Discrepancies Between the Two Methods

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Abstract

Background There is still controversy about whether transthoracic echocardiography (TTE) can provide reliable estimations
of pulmonary artery pressures (PAP). The primary endpoint of this study was to evaluate the
correlation between TTE and right heart catheterisation (RHC) in estimating systolic (SPAP) and mean
(MPAP) pulmonary artery pressures.
Methods Between January 2011 and December 2018, 141 consecutive patients (average age 63.6611.5 years; 84
women) with suspected or confirmed pulmonary hypertension (PH) were enrolled into this retrospective
observational monocentric study. All patients underwent TTE and, within 3 hours, RHC. The correlation
between TTE and RHC in estimating both SPAP and MPAP was retrospectively determined.
Results Seventeen (17) of the patients were excluded due to insufficient TTE signal quality. Of the remaining 124
patients, 18 had no PH. There was moderate correlation between both SPAP and MPAP estimated by TTE
and those assessed by RHC (r=0.65 and r=0.60, respectively). Bland-Altman analysis revealed a bias of
–11.9 mmHg (with the 95% limits of agreement ranging –45.4 to 121.5 mmHg) for SPAP estimation and
–4.6 mmHg (with the 95% limits of agreement ranging –27.9 to 118.8 mmHg) for MPAP estimation,
suggesting a general overestimation of PAP by TTE. The main factors responsible for discrepancies between
TTE and RHC were: female gender, arrhythmic cardiac electrical activity, systemic arterial hypertension,
and diuretic treatment.
Conclusions Transthoracic echocardiography frequently overestimated PAP in comparison with RHC, especially in
hypertensive women with arrhythmias and under diuretic treatment.