Chest
Volume 96, Issue 6, December 1989, Pages 1258-1262
Journal home page for Chest

Clinical Investigations
Noninvasive Estimation of Systolic Pulmonary Artery Pressure Using Doppler Echocardiography in Patients with Chronic Obstructive Pulmonary Disease

https://doi.org/10.1378/chest.96.6.1258Get rights and content

In patients with acquired or congenital heart diseases, the systolic pulmonary artery pressure (PAPs) can be predicted using continuous-wave Doppler ultrasound (CWD) measurement of the peak velocity of a tricuspid regurgitation (TR) jet. The aim of this study was to determine whether CWD could be used to accurately estimate PAP in patients with chronic obstructive pulmonary disease (COPD). In 41 patients with stable COPD, we prospectively performed CWD and right heart catheterization. The mean value of PAPs for the entire group was 38.5±14.9 mm Hg. Pulmonary arterial hypertension (PAPs ≥35 mm Hg) occurred in 51 percent (21/41) of patients. Doppler estimation of PAP was impossible in 34 percent (14/41) because of poor signal quality (n=3), absence of Doppler-detected TR (n = 8), and inadequate TR Doppler signal (n=3). The PAP could be estimated in 66 percent (27/41) of patients. A statistically significant correlation was found between the Doppler-estimated PAP and the catheter-measured PAPs (r=0.65; p<0.001; SEE = 9 mm Hg). Therefore, CWD appears to be useful for the noninvasive estimation of PAP in patients with COPD. However, this method is associated with two limitations: (1) the high percentage of patients in whom the PAP cannot be estimated by CWD, mainly because of the absence of Doppler-detected TR, and (2) the high value of the standard error of the estimate. The combination of CWD with other Doppler methods should increase the feasibility and accuracy of Doppler echography for the prediction of PAP in patients with COPD.

Section snippets

Patients and Methods

The group included 41 consecutive patients with COPD (32 male and nine female patients) who were referred for right heart catheterization. These patients had either chronic bronchitis, characterized by cough and sputum during at least three months of the year for at least two consecutive years, or emphysema characterized by dyspnea with radiologic evidence of emphysema and functional evidence of airway obstruction (FEV1/FVC <55 percent). The patients were in stable condition during the three

Results

The hemodynamic data are summarized in Table 2. The mean value of systolic PAP for the entire group was 38.5±14.9 mm Hg. Fifty-one percent (21/41) of patients had pulmonary arterial hypertension.

An analyzable Doppler tricuspid diastolic signal was obtained in 93 percent (38/41) of patients. The echo-Doppler did not detect TR in eight patients: seven of these eight patients had normal PAP. In 73 percent (30/41) of patients, the echo-Doppler detected a TR, but in three of them, the Doppler signal

Discussion

This prospective study demonstrated in a group of 41 patients with COPD that CWD could be used to estimate PAPs in 66 percent of patients. There was a statistically significant correlation (r=0.65, p<0.001) between the Doppler-estimated PAP and the catheter-measured PAPs. Continuous-wave Doppler ultrasound detected the presence of PAH with a high sensitivity (94 percent). When CWD did not detect a TR or when the Doppler-estimated PAP was below 35 mm Hg, the presence of PAH was highly unlikely.

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    Manuscript received February 22; revision accepted June 1.

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