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Original Research: Pulmonary Procedures |

Role of Transthoracic Contrast Echocardiography in the Clinical Diagnosis of Hereditary Hemorrhagic TelangiectasiaDiagnosis of Hereditary Hemorrhagic Telangiectasia

Sebastiaan Velthuis, MD; Veronique M. M. Vorselaars, MD; Marco W. F. van Gent, MD, PhD; Cornelis J. J. Westermann, MD, PhD; Repke J. Snijder, MD; Johannes J. Mager, MD, PhD; Martijn C. Post, MD, PhD
Author and Funding Information

From the Department of Cardiology (Drs Velthuis, Vorselaars, van Gent, and Post) and Department of Pulmonology (Drs Westermann, Snijder, and Mager), St. Antonius Hospital, Nieuwegein, The Netherlands.

Correspondence to: Sebastiaan Velthuis, MD, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands; e-mail: S.Velthuis@antoniusziekenhuis.nl


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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


Chest. 2013;144(6):1876-1882. doi:10.1378/chest.13-0716
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Background:  Hereditary hemorrhagic telangiectasia (HHT) can be diagnosed according to the four clinical Curaçao criteria, including the presence of pulmonary arteriovenous malformations (PAVMs). In the past few years, transthoracic contrast echocardiography (TTCE) replaced chest high-resolution CT (HRCT) imaging for the screening of PAVMs. The objective of this study was to determine whether the presence of any pulmonary shunt on TTCE can be accepted as a new clinical Curaçao criterion in diagnosing HHT.

Methods:  Between 2004 and 2012, we included 487 first-degree relatives of known HHT-causing mutation carriers who underwent both TTCE and chest HRCT imaging to screen for PAVMs. A quantitative three-point grading scale was used to differentiate among minimal, moderate, or extensive pulmonary shunt on TTCE (grade 1-3). Genetic testing was performed in all people and considered the gold standard for the diagnosis of HHT.

Results:  Chest HRCT imaging demonstrated PAVMs in 114 of 218 patients (52.3%) with a pulmonary shunt on TTCE. The addition of any pulmonary shunt on TTCE to the current clinical Curaçao criteria increased the number of positive criteria in 92 of 487 individuals (18.9%), which increased the sensitivity in diagnosing HHT from 88% to 94% at the expense of a decreased specificity from 74% to 70%. Accepting only pulmonary shunt grades ≥ 2 on TTCE as a diagnostic criterion for HHT enhanced the number of positive criteria in 30 (6.2%) individuals, which led to an increased sensitivity of 90% with no decrease in specificity (74%).

Conclusions:  The addition of only pulmonary shunt grades ≥ 2 on TTCE to the current clinical Curaçao criteria increases its sensitivity without affecting specificity in the diagnosis of HHT.

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