Comparison of transthoracic echocardiography and right heart catheterization for assessing pulmonary arterial pressure in patients with congenital or valvular heart defects

Background- Although right heart catheterization (RHC) has acceptable accuracy for the measurement of pulmonary arterial pressure (PAP), significant risks and cost issues are worrisome. Thus, a non-invasive technique such as echocardiography for assessing PAP would clearly be of great clinical value. We aimed to compare estimated systolic PAP (SPAP) by echocardiogram with the actual RHC measurements in the two groups of congenital and valvular heart diseases (CHD and VHD, respectively), in whom pulmonary hypertension (PHT) was clinically suspected. Methods- A total of 103 consecutive patients with confirmed CHD or VHD referred to our center between January and December 2009 were studied. Participants underwent transthoracic echocardiography and RHC within 4 hours of each other. Results- The mean SPAP in the CHD group was no different measured by RHC or echo (46.49 ± 29.04 vs. 46.45 ± 23 mmHg, p = 0.541). The mean SPAP in the VHD group measured by RHC was significantly higher than that measured by echo (48.70 ± 14.50 vs. 44.90 ± 11.0 mmHg, p = 0.041). Fifty-one (49.5) patients were found to have PHT at RHC. Echocardiography correctly identified 48 of these patients (sensitivity= 94.1). Nineteen of the 52 patients without PHT on RHC were correctly identified by echocardiography (specificity= 36.5). The positive and negative predictive values for echocardiography in assessing the presence or absence of PHT were 59.3 and 86.4, respectively. Conclusion- Integration of hemodynamic data with the echo examination can appropriately provide comprehensive assessment of PHT with high sensitivity in individual patients with congenital or valvular heart defects