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Comparative Study
. 2008 Sep;102(9):1305-10.
doi: 10.1016/j.rmed.2008.03.022. Epub 2008 Jul 10.

Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis

Steven D Nathan  1 , Oksana A Shlobin, Scott D Barnett, Rajeev Saggar, John A Belperio, David J Ross, Shahzad Ahmad, Rajan Saggar, Eric Libre, Joseph P Lynch 3rd, David A Zisman
Affiliations
Comparative Study

Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis

Steven D Nathan et al. Respir Med. 2008 Sep.

Abstract

Rationale: Pulmonary hypertension (PH) commonly complicates the course of patients with idiopathic pulmonary fibrosis (IPF). It has a significant impact on outcomes and is, therefore, important to detect.

Objectives: We sought to characterize the accuracy and performance characteristics of the right ventricular systolic pressure (RVSP) as estimated by echocardiography (ECHO) alone and in conjunction with physiologic indices in predicting the presence of PH in IPF patients.

Methods: Cross-sectional study of IPF patients from two large tertiary centers in whom both ECHO and right-heart catheterization (RHC) were available.

Measurements and main results: There were 110 patients with available ECHOs and RHCs. Estimates of RVSP were reported in 60 of these patients (54.5%) of whom 22 (36.6%) had PH, while 16 of the 50 patients without RVSP estimate (32%) had PH. Twenty-four of 60 (40%) ECHOs accurately reflected the pulmonary arterial systolic pressure as measured by RHC. An optimal RVSP threshold for the screening of PH could not be detected. When assessed in combination with various thresholds of PFT and 6-minute walk test (6MWT) parameters, the performance characteristics of the RVSP were slightly improved.

Conclusion: The RVSP is not an accurate test for the assessment of PH in IPF patients. Awareness of the various combinations of threshold values for RVSP with and without PFT and 6MWT might nonetheless assist clinicians in risk stratifying IPF patients for the presence of PH.

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Figures

Figure 1
Figure 1
Accuracy of the RVSPecho compared to the PAScath pressure as measured by right-heart catheterization in relation to the FVC% predicted.
Figure 2
Figure 2
Accuracy of the RVSPecho compared to the PASPcath pressure as measured by right-heart catheterization in relation to the mean PAP.
Figure 3
Figure 3
Diagnostic accuracy of incremental thresholds of the RVSPecho for the detection of PH in IPF depicted as a receiver operator characteristic curve.
See this image and copyright information in PMC

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