Correlation between Echocardiographic Pulmonary Artery Pressure Estimates and Right Heart Catheterization Measurement in Liver Transplant Candidates
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BACKGROUND: Patients undergoing liver transplant have worse outcomes in the presence ofpulmonary hypertension. Correlation between echocardiography and catheterization derivedpressures in this population is not well studied. Our study's aim is to show the relationshipbetween pulmonary artery systolic pressure derived from transthoracic echo (ePASP) withpulmonary artery systolic pressure measured during right heart catheterization (cPASP). METHODS: Single center retrospective study, patients being evaluated for liver transplant(n = 31) who had an interpretable Doppler signal for ePASP and had right heart catheterization(RHC) measurements within 3 months constituted the study group. Control group (n = 49)consisted of patients who did not have liver disease. RESULTS: There was modest correlation between ePASP and cPASP (R = 0.58, p < 0.001) in LTcandidates (n = 31) compared with the control group (R = 0.74, p < 0.001, n = 49). The 95%limits of agreement by Bland-Altman analysis ranged from +33.6 mmHg to −21.7 mmHg. Using receiver operating characteristic analysis, ePASP cut-off > 47 mmHg was 59% sensitiveand 78% specific to diagnose pulmonary artery (PA) hypertension (mean PA pressure > 25mmHg) in the LT candidates, while a similar cutoff performed well in the control group(cutoff > 43 mmHg, n = 47, 91% sensitive, 100% specific). CONCLUSIONS: Compared with other disease states, ePASP correlates modestly with cPASPin patients with advanced liver disease. A higher ePASP cutoff should be used to screen forpulmonary hypertension. A multi-center prospective study with simultaneous transthoracicechocardiography and RHC measurements is required to determine the best cut-off in thispopulation.
Abstract
BACKGROUND: Patients undergoing liver transplant have worse outcomes in the presence ofpulmonary hypertension. Correlation between echocardiography and catheterization derivedpressures in this population is not well studied. Our study's aim is to show the relationshipbetween pulmonary artery systolic pressure derived from transthoracic echo (ePASP) withpulmonary artery systolic pressure measured during right heart catheterization (cPASP). METHODS: Single center retrospective study, patients being evaluated for liver transplant(n = 31) who had an interpretable Doppler signal for ePASP and had right heart catheterization(RHC) measurements within 3 months constituted the study group. Control group (n = 49)consisted of patients who did not have liver disease. RESULTS: There was modest correlation between ePASP and cPASP (R = 0.58, p < 0.001) in LTcandidates (n = 31) compared with the control group (R = 0.74, p < 0.001, n = 49). The 95%limits of agreement by Bland-Altman analysis ranged from +33.6 mmHg to −21.7 mmHg. Using receiver operating characteristic analysis, ePASP cut-off > 47 mmHg was 59% sensitiveand 78% specific to diagnose pulmonary artery (PA) hypertension (mean PA pressure > 25mmHg) in the LT candidates, while a similar cutoff performed well in the control group(cutoff > 43 mmHg, n = 47, 91% sensitive, 100% specific). CONCLUSIONS: Compared with other disease states, ePASP correlates modestly with cPASPin patients with advanced liver disease. A higher ePASP cutoff should be used to screen forpulmonary hypertension. A multi-center prospective study with simultaneous transthoracicechocardiography and RHC measurements is required to determine the best cut-off in thispopulation.
참고문헌 (27)
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