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Comparative Study
. 2010 Apr 15;105(8):1192-7.
doi: 10.1016/j.amjcard.2009.11.048. Epub 2010 Mar 5.

Accuracy of noninvasively determined pulmonary artery systolic pressure

Jeffrey M Testani  1 , Martin G St John Sutton, Susan E Wiegers, Amit V Khera, Richard P Shannon, James N Kirkpatrick
Affiliations
Comparative Study

Accuracy of noninvasively determined pulmonary artery systolic pressure

Jeffrey M Testani et al. Am J Cardiol. .

Erratum in

  • Am J Cardiol. 2010 Oct 1;106(7):1060

Abstract

The noninvasive estimation of pulmonary artery systolic pressure (PASP) has become a standard component of the echocardiographic examination. Our aim was to evaluate the accuracy of this modality in a large series of unselected studies obtained in clinical practice. All right heart catheterizations during a 4-year period were reviewed. Studies with echocardiographic findings available within 48 hours were evaluated for PASP agreement. In an effort to mirror clinical practice, the right heart catheterization findings were used as the reference standard and the PASP values were taken directly from the respective clinical reports. Overall, 792 right heart catheterization-echocardiogram pairs were identified. Echocardiographic PASP could not be estimated in 174 of these studies (22.0%). The correlation between modalities was moderate, but agreement was poor (bias 9.0%, 95% limits of agreement -53.2% to 71.2%, r = 0.52, p <0.001). Misclassification of clinical PASP categories occurred more often than not (54.4%). Multivariate analysis using multiple potential sources of error could only account for 3.2% of the total variation in the discrepancy between the study modalities (p = 0.003). In conclusion, noninvasively estimated PASP had limited agreement with the invasively determined PASP, and misclassification of PASP clinical categories occurred frequently. Given the widespread use of echocardiographically determined PASP, these data are in need of replication in a large prospective study.

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Conflict of interest statement

All authors report no conflicts of interest relevant to this work.

Figures

Figure 1
Figure 1
Proportion of non-invasive pulmonary artery systolic pressure estimates discordant to invasively determined pulmonary artery systolic pressure by various different error cutoffs.
Figure 2
Figure 2
Bland-Altman plot of echocardiographically estimated and invasively measured pulmonary artery systolic pressures. Dashed lines represent 95% limits of agreement.
Figure 3
Figure 3
Figure 3A/B. Pie chart representation of PASP clinical category misclassification. Figure 3A represents number of PASP clinical categories misclassified in the total cohort. Figure 3B represents a breakdown of studies with overestimated and underestimated PASP clinical categories. PASP: Pulmonary artery systolic pressure.
See this image and copyright information in PMC

Comment in

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