COMPARISON OF ACCURACY OF THREE ECHOCARDIOGRAPHY METHODS USED FOR DETECTION OF PULMONARY HYPERTENSION

Echocardiography is a valuable tool for detection of pulmonary hypertension (PHT) but little work has been done to compare the accuracy of this non-invasive method with invasive direct trans-catheter pulmonary artery pressure (PAP) measurement. The aim of this study is to compare the accuracy of different echocardiography methods in detection of PHT. Material and Methods: In a prospective double blind study 49 patients (female: 33 and male: 16) with an age range of 14-68 years (39:t 12) and various cardiovascular disorders were selected. Tricuspid regurgitation (TR) gradient was measured by continuous wave (CW) doppler, pulmonary artery acceleration time (PAT) by pulse wave doppler, and PA a-dip evaluated by M-mode echocardiography. Data analysis was performed by SPSS software. Results: Among 46 patients with measurable PAT, 22 had PAT < 100 ms, and 24 had values> 100 ms. In the group with PAT < 100 ms (n=22), 18 had trans-catheter measured mean pulmonary artery pressure (PAP) >20 mmHg while it was < 20 mmHg in four patients. Among 24 patients with PAT> 100 msec, in 10 patients measured mean pulmonary artery pressure (MPAP) was <20 mmHg, and in 14 patients, MPAP was >20 mmHg. (P=0.024, sensitivity: 60%, specificity: 75%). With respect to TR gradient (n=28), in 21 individuals trans-catheter measured MPAP was >20 mmHg; and in seven patients it was <20 mmHg (P < 0.0002, sensitivity: 93%, specificity: 98%). In 30 patients with demonstrable PA a-dip, it was present in 20 and absent in 10 patients. In the PA a-dip present group (n=20), 10 patients had MPAP >'20 mmHg, and in the rest of the patients MPAP was <20 mmHg. In the PA a-dip absent group (n = 10), seven patients had MPAP> 20 mmHg, and 3 patients had MPAP< 20 mmHg (P: 0.297, sensitivity: 58%, specificity: 23%). A proposed formula for estimation of PAP through TR gradient was suggested. Conclusion: This study shows that TR gradient is a non-invasive measurement for detection of PHT, with high grade of catheterization correlation, PAT is moderately specific, while M-mode PA a-dip measurement is neither sensitive nor specific.