Correlation of transthoracic echocardiography and right heart catheterization in pregnancy

Abstract

Objectives: To correlate estimated pulmonary artery pressures (PAP) by echocardiography with right heart catheterization (RHC) measurements and to correlate estimated left ventricular ejection fraction (EF) by echocardiography with cardiac output (CO) measurements by RHC.

Study design: All women who had echocardiography at a single institution during a 6-year period and underwent RHC during pregnancy were included. Echocardiography estimates of right ventricular systolic pressure (RVSP) and EF were correlated with measured RHC PAP and CO, respectively.

Results: Eighteen patients underwent 21 RHCs, 10 antepartum at the catheterization laboratory and the remaining 11 intrapartum, performed with the use of a pulmonary artery catheter placed prior to the onset or induction of labor. Correlation between RVSP and PAP was good (rho=0.79, P<0.0001); nonetheless, in 30% of cases RHC eliminated the concern for pulmonary hypertension (PHTN). There was minimal correlation between EF and CO.

Conclusion: Despite good statistical correlation between echocardiography and RHC for determining pulmonary artery pressure, RHC should be considered for major decisions such as pregnancy interruption or preterm delivery given the proportion of cases where concern for PHTN was excluded by RHC. EF provides a poor proxy for CO.