DOPPLER ECHOCARDIOGRAPHIC EVALUATION OF PULMONARY-ARTERY PRESSURE IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - A EUROPEAN MULTICENTER STUDY

The feasibility, reproducibility and reliability of Doppler echocardiography in evaluation of pulmonary artery pressure in patients with chronic obstructive pulmonary disease (COPD) were determined in a multicentre study. In 100 COPD patients with mean pulmonary artery pressure ranging from 10 to 62 mmHg at cardiac catheterization, pulmonary pressure estimation was attempted by four Doppler echocardiographic methods. These methods comprised the calculation of transtricuspid and transpulmonary pressure gradients from Doppler-detected tricuspid or pulmonary regurgitation, the evaluation of right ventricular outflow tract velocity profiles with the measurement of right ventricular systolic time intervals and the measurement of the right ventricular isovolumic relaxation time. In 98 (98%) patients at least one of the methods could be employed. A tricuspid regurgitation jet was detected in 47 (47%) patients but its quality was adequate for measurement in 30 (30%). Pulmonary regurgitation jet velocity was measurable only in five cases. The standard error of estimate in testing intra- and interobserver reproducibility of Doppler systolic time intervals was <5%. The predictive value of right ventricular outflow tract acceleration time < 90 ms in the identification of patients with mean pulmonary artery pressure > 20 mmHg was 80%. Of Doppler echocardiographic data, best correlations with mean pulmonary artery pressure were found for the transtricupidgradient (r = 0.73, SEE= 7.4 mmHg), for the right ventricular acceleration time (r = -0.65, SEE =8 mmHg) and right ventricular isovolumic relaxation time (r = 0.61, SEE =8.5 mmHg). Doppler echocardiographic prediction of pulmonary artery pressure, based on measurement of right ventricular time intervals, is feasible in a large proportion of COPD patients, but lacks accuracy. Doppler evaluation of transtricuspid jet velocity allows a reasonable quantitative assessment of pulmonary artery pressure but its application is limited by topographic factors. At this stand, in COPD patients Doppler echocardiography should be considered a convenient screening technique to identify different degrees of severity of pulmonary hypertension. Doppler echocardiography, pulmonary artery pressure, chronic obstructive pulmonary disease. © 1991 The European Society of Cardiology.