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LETTER TO THE EDITOR
Year : 2013  |  Volume : 8  |  Issue : 2  |  Page : 127-128
Author's reply


1 Division of Pulmonary Medicine, Riyadh Military Hospital, Riyadh, Saudi Arabia
2 Department of Cardiology, Prince Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia

Date of Web Publication30-Mar-2013

Correspondence Address:
Majdy M Idrees
Division of Pulmonary Medicine, Riyadh Military Hospital, Riyadh
Saudi Arabia
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How to cite this article:
Idrees MM, Batubara E, Kashour T. Author's reply. Ann Thorac Med 2013;8:127-8

How to cite this URL:
Idrees MM, Batubara E, Kashour T. Author's reply. Ann Thorac Med [serial online] 2013 [cited 2019 Dec 15];8:127-8. Available from: http://www.thoracicmedicine.org/text.asp?2013/8/2/127/109846


Sir,

Dr. Yalcinkaya [1] pointed out a very important concept for the limitation of 2 dimentional echocardiography (2D) in the assessment of RV function and morphology. Such limitation forced all guidelines to consider the right heart catheterization (RHC) as the standard technique for the accurate assessment of right ventricular function in patients with pulmonary hypertension (PH).

A number of studies addressed the issue of reliability of Doppler echocardiography in detecting and quantifying PH. TR jets are analyzable in 39 to 86% of patients. [2],[3] The variability points out that technical and operator factors can affect the usefulness of this test. In a cohort study of 374 lung-transplant candidates, [4] the accuracy of echocardiography compared with RHC in the determination of systolic pulmonary artery pressure (sPAP) and diagnosis of PH were investigated. The prevalence of PH was 25% in the study population. Estimation of sPAP by echocardiography was achieved in 166 patients (44%). However, 52% of pressure estimations were found to be inaccurate (more than 10 mm Hg difference compared with measured pressure), and 48% of patients were misclassified as having PH by echocardiography. Sensitivity, specificity, and positive and negative predictive values of sPAP estimation for diagnosis of PH were 85, 55, 52, and 87%, respectively. Because of these limitations, combined parameters projections other than sPAP have been used to improve echocardiographic accuracy for diagnosing and assessing the severity of PH. These include tricuspid annular plane systolic excursion (TAPSE), pre-ejection period, acceleration and deceleration, relaxation, and contraction times. [5],[6],[7] However, most of these parameters were used clinically in a setting of chronic PH and, to our knowledge, there is no data to test their usefulness and accuracy in conditions leading to acute PH, such as pulmonary embolism.

In our case series, [8] we tried to enhance the accuracy of 2D echo results by using both quantitative and qualitative criteria.

Acknowledging the points raised by Dr. Yalcinkaya, we believe that further studies are needed before adopting combined parameters projections for the assessment of RV function in acute setting of PH.

 
   References Top

1.Yalcinkaya E, Bugan B, Celik M, Yuksel UC. Evaluation of right ventricle with echocardiography: Utility of combined techniques. Ann Thorac Med 2013;8:127.  Back to cited text no. 1
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2.Murata I, Kihara H, Shinohara S, Ito K. Echocardiographic evaluation of pulmonary arterial hypertension in patients with progressive systemic sclerosis and related syndromes. Jpn Circ J 1992;56:983-91.  Back to cited text no. 2
    
3.Borgeson DD, Seward JB, Miller FA Jr, Oh JK, Tajik AJ. Frequency of Doppler measurable pulmonary artery pressures. J Am SocEchocardiogr 1996;9:832-7.  Back to cited text no. 3
    
4.Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Resp Crit Care Med 2003;167:735-40.  Back to cited text no. 4
    
5.Isobe M, Yazaki Y, Takaku F, Koizumi K, Hara K, Tsuneyoshi H, et al. Prediction of pulmonary arterial pressure in adults by pulsed Doppler echocardiography. Am J Cardiol 1986;57:316-21.  Back to cited text no. 5
    
6.Nagaya N, Satoh T, Uematsu M, Okano Y, Kyotani S, Nakanishi N, et al. Shortening of Doppler-derived deceleration time of early diastolic transmitral flow in the presence of pulmonary hypertension through ventricular interaction. Am J Cardiol 1997;79:1502-6.  Back to cited text no. 6
    
7.Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T, et al. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 1983;68:302-9.  Back to cited text no. 7
    
8.Idrees MM, Batubara E, Kashour T. Nover approach for the management of sub-massive pulmonary embolism. Ann Thorac Med 2012;7:157-61.  Back to cited text no. 8
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