Accuracy and precision of echocardiography versus right heart catheterization for the assessment of pulmonary hypertension
Accuracy and precision of echocardiography versus right heart catheterization for the assessment of pulmonary hypertension
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DOI：
10.1016/j.ijcard.2013.07.005
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发表时间：
2013-10-09
影响因子：
3.5
通讯作者：
Naeije, Robert
中科院分区：
文献类型：
--
作者：
D'Alto, Michele;Romeo, Emanuele;Naeije, Robert
背景资料：超声心动图研究有助于了解肺循环的病理生理学，并已被证明是有用的肺动脉高压的筛查和诊断，但被认为是不可靠的肺动脉高压的诊断。我们探索了这个明显的矛盾与严格的Bland和Altman分析的准确性和精密度的测量收集在一个大的患者population.Methods：共161例患者提到的怀疑肺动脉高压进行了前瞻性评价多普勒超声心动图由专门的心脏病专家进行1小时内的指示右心导管插入术。结果：9例患者（6%）因信号质量不足而被排除。在其余152例患者中，10例（7%）没有肺动脉高压，大多数其他患者有不同严重程度的肺动脉高压（36%）或肺静脉高压（40%）。超声心动图和导管插入术的平均肺动脉压、左心房压和心输出量几乎相同，无偏倚，置信区间分别为+/- 3 mm Hg、+/- 5 mm Hg和+/- 0.3 L/min。然而，平均肺动脉压的一致性± 2SD限值分别为+ 19和-18 mm Hg，左房压为+8和-12 mm Hg，心输出量为+1.8和-1.7 L/min。结论：多普勒超声心动图可以准确测量肺循环，但精度中等，这解释了为什么该程序适用于人群研究，但不能用于肺动脉高压的个体诊断。(C)2013爱思唯尔爱尔兰有限公司版权所有。
Background: Echocardiographic studies have contributed to progress in the understanding of the pathophysiology of the pulmonary circulation and have been shown to be useful for screening for and prognostication of pulmonary hypertension, but are considered unreliable for the diagnosis of pulmonary hypertension. We explored this apparent paradox with rigorous Bland and Altman analysis of the accuracy and the precision of measurements collected in a large patient population.Methods: A total of 161 patients referred for a suspicion of pulmonary hypertension were prospectively evaluated by a Doppler echocardiography performed by dedicated cardiologists within 1 h of an indicated right heart catheterization.Results: Nine of the patients (6%) were excluded due to an insufficient signal quality. Of the remaining 152 patients, 10 (7%) had no pulmonary hypertension and most others had either pulmonary arterial hypertension (36%) or pulmonary venous hypertension (40%) of variable severities. Mean pulmonary artery pressure, left atrial pressure and cardiac output were nearly identical at echocardiography and catheterization, with no bias and tight confidence intervals, respectively +/- 3 mm Hg, +/- 5 mm Hg and +/- 0.3 L/min. However, the +/- 2SD limits of agreement were respectively of + 19 and -18 mm Hg for mean pulmonary artery pressure, + 8 and -12 mm Hg for left atrial pressure and + 1.8 and -1.7 L/min for cardiac output.Conclusions: Doppler echocardiography allows for accurate measurements of the pulmonary circulation, but with moderate precision, which explains why the procedure is valid for population studies but cannot be used for the individual diagnosis of pulmonary hypertension. (C) 2013 Elsevier Ireland Ltd. All rights reserved.