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Point/Counterpoint Editorials |

Point: Can Doppler Echocardiography Estimates of Pulmonary Artery Systolic Pressures Be Relied Upon to Accurately Make the Diagnosis of Pulmonary Hypertension? YesAccuracy of Doppler Echocardiography? Yes

Lawrence G. Rudski, MD
Author and Funding Information

From the Division of Cardiology, Department of Medicine, Jewish General Hospital, McGill University.

Correspondence to: Lawrence G. Rudski, MD, Jewish General Hospital, 3755 Côte-Sainte-Catherine Rd, Montreal, QC, H3T 1E2, Canada; e-mail: lrudski@jgh.McGill.ca


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Rudski is a minor shareholder in GE, which manufactures both cath labs and ultrasound.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1533-1536. doi:10.1378/chest.13-0296
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Extract

It is often said that perfect is the enemy of good. A disease screening procedure can never be perfect and almost always represents a balance between positive and negative predictive values while factoring in patient risk and costs to society. Although physicians are taught to strive for perfect, when balancing the aforementioned, we must strive for good enough.

Pulmonary hypertension (PH) often represents a diagnostic challenge when relying on bedside tools, including history and physical examination. It is, however, a serious hemodynamic consequence of a variety of medical conditions and imparts significant morbidity and reduced life span when severe. Although right-sided heart catheterization (RHC) is required to confirm a diagnosis of PH, it is apparent that performing RHC on all patients with dyspnea would be costly, bear excessive risk, and be impractical in our current cost-constrained environment. We are better served by a noninvasive test that provides a compromise among accuracy, safety, simplicity, and cost. Echocardiography provides this combination. Appropriate Use Criteria consider echocardiography appropriate as the initial study in the workup of suspected PH and any patient with dyspnea and a suspected cardiac etiology.1

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