Echocardiography and right heart catheterization in pulmonal hypertension [Echokardiographie und Rechtsherzkatheterisierung bei pulmonaler Hypertonie]

摘要

Background and objective: Since pulmonary hypertension is defined haemodynamically with a mean pulmonary artery pressure (mPAP) of at least 25 mmHg, right heart catheterization is mandatory for diagnosis of PH. However, it remains unclear if echocardiography can always detect a PH and to what extent echocardiographic and invasive parameters correlate. We aimed to determine the frequency of right heart valve insufficiencies, the correlation of mPAP measured invasively and estimated by echocardiography and the correlation of other echocardiographic parameters with invasively measured cardiac output (CO) and pulmonary vascular resistance (PVR) in patients who presented at our center for pulmonary hypertension. Methods: Retrospective analysis of echocardiographic and invasively measured parameters in consecutive patients who presented with dyspnea and suspected PH. Results: 10% of the patients with invasively confirmed PH had no tricuspid valve insufficiency, 61.3% had no pulmonary valve insufficiency. The highest correlation of invasively measured mPAP was found for mPAP estimated non-invasively via RVSP (R = 0.80; < 0.0001). Correlation of non-invasively estimated mPAP by the pulmonary valve regurgitation (R = 0,72, p < 0,004) and mPAP measured by the right ventricular outflow tract flow acceleration time (R = 0,54, p < 0.0001) with invasively measured mPAP were inferior. Left ventricular eccentricity index and systolic tissue Doppler velocity of tricuspid annulus correlated highly significant with PVR, TAPSE correlated with PVR and CO. Right ventricular myocardial performance index correlated with CO. Conclusion: In 10% of invasively proven PH, the diagnosis can be missed by estimation of RVSP by echocardiography alone, due to a lack of tricuspid valve insufficiency. Echocardiographic assessment of mPAP remains difficult. Echocardiography can deliver qualitative information about CO and PVR. Right heart catheterization remains mandatory to confirm or to rule out PH.