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The Role of Doppler Echocardiography in Pulmonary Artery Hypertension: The Importance of Proving the Obvious

Ian Paterson, MD; Evangelos D. Michelakis, MD
Author and Funding Information

From the School of Internal Medicine, University of Alberta.

Correspondence to: Evangelos D. Michelakis, MD, School of Internal Medicine, University of Alberta, 11043 89 Ave, Edmonton, AB, T6G 2M7, Canada; e-mail: em2@ualberta.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Paterson has reported that his research programs and his institution have received funds from Roche and Servier, but he has not received any personal compensation from these. Dr Michelakis has enrolled patients in trials by Eli Lilly, Bayer, and United Therapeutics, and the University of Alberta has received funds for the cost of procedures, but Dr Michelakis has not received any personal compensation for these trials. He also has received honoraria from Pfizer, United Therapeutics, and Bayer.

Funding/Support: Both authors are funded by the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Canada.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):973-975. doi:10.1378/chest.10-2837
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Extract

The characters in Eugene Ionesco’s The Bald Soprano (one of the founding plays of the Theater of the Absurd) sit and talk, repeating the obvious until it starts sounding like nonsense. It is sometimes surprising how difficult it is to convince even scientists of the obvious.

In a well-conducted study in this issue of CHEST (see page 988), Rich et al1 remind us of the obvious and known fact that the estimation of pulmonary artery pressure (PAP) by Doppler echocardiography (DE) does not necessarily correlate with the measurement of PAP taken directly by right-sided heart catheterization (RHC). With a carefully conducted set of experiments and an appropriate statistical analysis, the authors show definitively that the estimated pulmonary artery systolic pressure (PASP), based on tricuspid regurgitant jet velocity (TRV), does not correlate with true PASP or mean PAP (mPAP) in a large cohort of patients with pulmonary hypertension. The authors examined the correlation and agreement between RHC and DE in a large cohort of 160 patients with pulmonary hypertension undergoing both tests within 30 days. In a smaller group of 23 patients, simultaneous measurements through RHC and DE were performed. In both instances, the authors found only a moderate correlation between RHC- and DE-derived PASP (r =0.7). Furthermore, Bland-Altman analysis revealed a >10-mm Hg difference 51% of the time. The study does not describe a novel finding. It is, however, a very important study because of its careful methodology and timing.

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