TY - JOUR
T1 - Doppler echocardiography inaccurately estimates right ventricular pressure in children with elevated right heart pressure
AU - Groh, Georgeann K.
AU - Levy, Philip T.
AU - Holland, Mark R.
AU - Murphy, Joshua J.
AU - Sekarski, Timothy J.
AU - Myers, Craig L.
AU - Hartman, Diana P.
AU - Roiger, Rebecca D.
AU - Singh, Gautam K.
PY - 2014/2
Y1 - 2014/2
N2 - Background Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objectives of this study were to evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in pediatric patients and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure. Methods Eighty children (age range, 0-17.9 years; median age, 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and the right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid regurgitation. Patients were then grouped on the basis of RHC-measured RV systolic pressure (RVSP): group 1 (n = 43), with RVSP < 1/2 systemic systolic blood pressure (SBP); group 2 (n = 37), with RVSP ≥ 1/2 SBP; group 3 (n = 56), with RVSP < 2/3 SBP; and group 4 (n = 24), with RVSP ≥ 2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10 mm Hg. Results Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in one of 43 patients in group 1 (2%) versus nine of 37 in group 2 (24%) and was inaccurate in one of 56 patients in group 3 (2%) versus eight of 24 in group 4 (33%). Overestimation and underestimation occurred equally in all groups. Conclusion DE inaccurately estimates RV pressure in children with elevated right heart pressure. It should not be relied on as the sole method of assessing right heart hemodynamics in children with RV hypertension.
AB - Background Doppler echocardiography (DE) is widely used as a surrogate for right heart catheterization (RHC), the gold standard, to assess and monitor elevated right heart pressure in children. However, its accuracy has not been prospectively validated in children. The objectives of this study were to evaluate the accuracy of DE in predicting simultaneously measured right ventricular (RV) pressure by RHC in pediatric patients and to determine if the degree of RV hypertension affects the accuracy of DE in assessing right heart pressure. Methods Eighty children (age range, 0-17.9 years; median age, 5.5 years) with two-ventricle physiology and a wide range of right heart pressures underwent simultaneous DE and RHC. The pressure gradient between the right ventricle and the right atrium was directly measured by RHC and simultaneously estimated by DE using tricuspid regurgitation. Patients were then grouped on the basis of RHC-measured RV systolic pressure (RVSP): group 1 (n = 43), with RVSP < 1/2 systemic systolic blood pressure (SBP); group 2 (n = 37), with RVSP ≥ 1/2 SBP; group 3 (n = 56), with RVSP < 2/3 SBP; and group 4 (n = 24), with RVSP ≥ 2/3 SBP. Correlation and Bland-Altman analyses were performed on all groups. Accuracy was predefined as 95% limits of agreement within ±10 mm Hg. Results Despite a reasonable correlation between DE and RHC in all groups, there was poor agreement between techniques as RVSP/SBP increased. DE was inaccurate in one of 43 patients in group 1 (2%) versus nine of 37 in group 2 (24%) and was inaccurate in one of 56 patients in group 3 (2%) versus eight of 24 in group 4 (33%). Overestimation and underestimation occurred equally in all groups. Conclusion DE inaccurately estimates RV pressure in children with elevated right heart pressure. It should not be relied on as the sole method of assessing right heart hemodynamics in children with RV hypertension.
KW - Children
KW - Doppler echocardiography
KW - Right ventricle
KW - Tricuspid regurgitation
UR - http://www.scopus.com/inward/record.url?scp=84893674967&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2013.09.016
DO - 10.1016/j.echo.2013.09.016
M3 - Article
C2 - 24183542
AN - SCOPUS:84893674967
SN - 0894-7317
VL - 27
SP - 163
EP - 171
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 2
ER -