Accuracy of Pulmonary Artery Pressure on Trans-Thoracic ECHO in Comparison with Pressures Measured on Right Heart Catheterization in a Community Hospital

Abstract

Pulmonary hypertension is a condition with high morbidity and mortality. Trans-thoracic echocardiogram (TTE) is the screening test of choice for pulmonary hypertension, with right heart catheterization (RHC) used for confirmation or, if diagnostic suspicion persists despite a normal TTE. In a systematic review and meta-analysis of 29 studies, TTE was found to have a sensitivity of 83% and a specificity of 72% for diagnosing pulmonary HTN, though there was heterogeneity between studies. Performance of TTE vs. RHC (gold standard) is unknown in a community hospital. In our retrospective review, 26 patients were included who had a TTE and RHC within 3 months of each other. Using statistical (t-tests and correlations) and graphical (Bland-Altman) methods, our results demonstrated a statistically significant association between RVSP and RAP measured on echocardiogram and RHC. At the same time, we found that echo measurements for RVSP and RAP tended to overestimate relative to the true value though overall the echo measurements were reliable in the sense of having low variability. In conclusion, our results suggest TTE is consistently biased in a positive direction compared to RHC. The main limitations of our study are the small sample size and the length of time between the TTE and RHC measurements.