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Pulmonary hypertension in interstitial lung disease: limitations of echocardiography compared to cardiac catheterization

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Title: Pulmonary hypertension in interstitial lung disease: limitations of echocardiography compared to cardiac catheterization
Authors: Keir, GJ
John Wort, S
Kokosi, M
George, PM
Walsh, SLF
Jacob, J
Price, L
Bax, S
Renzoni, EA
Maher, TM
MacDonald, P
Hansell, DM
Wells, AU
Item Type: Journal Article
Abstract: BACKGROUND AND OBJECTIVE: In interstitial lung disease (ILD), pulmonary hypertension (PH) is a major adverse prognostic determinant. Transthoracic echocardiography (TTE) is the most widely used tool when screening for PH, although discordance between TTE and right heart catheter (RHC) measured pulmonary haemodynamics is increasingly recognized. We evaluated the predictive utility of the updated European Society of Cardiology/European Respiratory Society (ESC/ERS) TTE screening recommendations against RHC testing in a large, well-characterized ILD cohort. METHODS: Two hundred and sixty-five consecutive patients with ILD and suspected PH underwent comprehensive assessment, including RHC, between 2006 and 2012. ESC/ERS recommended tricuspid regurgitation (TR) velocity thresholds for assigning high (>3.4 m/s), intermediate (2.9-3.4 m/s) and low (<2.8 m/s) probabilities of PH were evaluated against RHC testing. RESULTS: RHC testing confirmed PH in 86% of subjects with a peak TR velocity >3.4 m/s, and excluded PH in 60% of ILD subjects with a TR velocity <2.8 m/s. Thus, the ESC/ERS guidelines misclassified 40% of subjects as 'low probability' of PH, when PH was confirmed on subsequent RHC. Evaluating alternative TR velocity thresholds for assigning a low probability of PH did not significantly improve the ability of TR velocity to exclude a diagnosis of PH. CONCLUSION: In patients with ILD and suspected PH, currently recommended ESC/ERS TR velocity screening thresholds were associated with a high positive predictive value (86%) for confirming PH, but were of limited value in excluding PH, with 40% of patients misclassified as low probability when PH was confirmed at subsequent RHC.
Issue Date: 1-Jul-2018
Date of Acceptance: 30-Nov-2017
URI: http://hdl.handle.net/10044/1/56082
DOI: https://dx.doi.org/10.1111/resp.13250
ISSN: 1323-7799
Publisher: Wiley
Start Page: 687
End Page: 694
Journal / Book Title: Respirology
Volume: 23
Issue: 7
Copyright Statement: © 2018 Asian Pacific Society of Respirology. This is the peer reviewed version of the following article: Keir, G.J., John Wort, S., Kokosi, M., George, P.M., Walsh, S.L.F., Jacob, J., Price, L., Bax, S., Renzoni, E.A., Maher, T.M., MacDonald, P., Hansell, D.M. and Wells, A.U. (2018) Pulmonary hypertension in interstitial lung disease: Limitations of echocardiography compared to cardiac catheterization. Respirology, which has been published in final form at https://dx.doi.org/10.1111/resp.13250. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
Sponsor/Funder: National Institute for Health Research
Arthritis Research UK
Funder's Grant Number: BRU 6279
Keywords: echocardiography
interstitial lung disease
pulmonary hypertension
right heart catheterization
11 Medical And Health Sciences
Respiratory System
Publication Status: Published
Online Publication Date: 2018-01-12
Appears in Collections:National Heart and Lung Institute