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Correspondence |

Echocardiography in Pulmonary HypertensionEchocardiography in Pulmonary Hypertension FREE TO VIEW

Carla Nobre, MD; Dinis Mesquita, MD; Boban Thomas, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine, Centro Hospitalar Barreiro Montijo.

Correspondence to: Carla Nobre, MD, Centro Hospitalar Barreiro Montijo, Internal Medicine, Avenida Movimento das Forças Armadas, Barreiro, Portugal 2830-094; e-mail: carlanobre.med@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2013;144(4):1426. doi:10.1378/chest.13-1399
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To the Editor:

In their well-elucidated point-counterpoint editorials in a recent issue of CHEST (June 2013), Rudski1 and Rich2 have described some of the advantages and pitfalls of echocardiography in the evaluation of pulmonary hypertension (PH). Although it is true that as practicing physicians and echocardiographers, we find the envelope of tricuspid regurgitation (TR) sometimes hard to evaluate, we have participated in a study on the use of Levovist (Bayer Healthcare Pharmaceuticals), a contrast agent, in the evaluation of systolic pulmonary artery pressure (sPAP) in patients with COPD, a difficult subset of patients to study, with deficient parasternal and apical views.3

We were able to elucidate the TR envelope in 49% of patients before contrast injection and 95% of patients after contrast injection. There was also an increase in the severity of TR after contrast. In those for whom a reliable signal was obtained before and after contrast agent, we detected a significant increase in the sPAP values after contrast (44 ± 10 mm Hg vs 56 ± 15 mm Hg, P <.01). To exclude the possibility that the contrast agent per se could cause an increase in the sPAP, we studied 15 patients in the cardiothoracic postoperative unit with right-sided heart catheters before and after the same contrast agent and found no increase in pressures after injection of contrast (35 ± 10 mm Hg vs 35 ± 9 mm Hg, P =not significant).

The discussion of the pitfalls of echocardiography revolves around the severity of estimated TR. Some of these pitfalls can be overcome by better techniques and careful attention to the interpretation of the numbers. As practicing physicians, we find echocardiography indispensable as a screening tool for patients with clinical features suggestive of PH, but it is ingenuous of anyone these days to claim that anything is a gold standard. We also agree that the use of echocardiography as the sole imaging technique to select patients for many therapies for PH is rather premature.

References

Rudski LG. Point: can Doppler echocardiography estimates of pulmonary artery systolic pressures be relied upon to accurately make the diagnosis of pulmonary hypertension? Yes. Chest. 2013;143(6):1533-1536. [CrossRef] [PubMed]
 
Rich JD. Counterpoint: can Doppler echocardiography estimates of pulmonary artery systolic pressures be relied upon to accurately make the diagnosis of pulmonary hypertension? No. Chest. 2013;143(6):1536-1539. [CrossRef] [PubMed]
 
Cabello B, Borrás X, Carreras F, Thomas B, Leta R, Pons-Lladó G. Improvement in the measurement technique of pulmonary artery pressure by Doppler echocardiography with contrast in chronic obstructive pulmonary disease [in Spanish]. Med Intensiva. 2010;34(8):506-512. [CrossRef] [PubMed]
 

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References

Rudski LG. Point: can Doppler echocardiography estimates of pulmonary artery systolic pressures be relied upon to accurately make the diagnosis of pulmonary hypertension? Yes. Chest. 2013;143(6):1533-1536. [CrossRef] [PubMed]
 
Rich JD. Counterpoint: can Doppler echocardiography estimates of pulmonary artery systolic pressures be relied upon to accurately make the diagnosis of pulmonary hypertension? No. Chest. 2013;143(6):1536-1539. [CrossRef] [PubMed]
 
Cabello B, Borrás X, Carreras F, Thomas B, Leta R, Pons-Lladó G. Improvement in the measurement technique of pulmonary artery pressure by Doppler echocardiography with contrast in chronic obstructive pulmonary disease [in Spanish]. Med Intensiva. 2010;34(8):506-512. [CrossRef] [PubMed]
 
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