Accuracy of Doppler echocardiographic estimates of pulmonary artery pressures in a canine model of pulmonary hypertension

Objectives: To compare noninvasive estimates of pulmonary artery pressure (PAP) obtained via echocardiography (ECHO) to invasive measurements of PAP obtained during right heart catheterization (RHC) across a range of PAP. To examine the accuracy of estimating right atrial pressure via ECHO (RAP(ECHO)) compared to RAP measured by RHC (RAP(RHC)), and determine if adding RAP(ECHO) improves the accuracy of noninvasive PAP estimations. Animals: 14 healthy female beagle dogs. Methods: Comparison of ECHO and RHC measures of PAP, both at normal PAP and increased PAP generated by microbead embolization. Results: Noninvasive estimates of PAP were moderately but significantly correlated (r of 0.68-0.78; p < 0.0006) with invasive measurements of PAP. Wide variance was noted for all estimations, with increased variance at higher PAP. The addition of RAP(ECHO) improved correlation and bias in all cases. RAP(RHC) was significantly correlated with RAP(ECHO) (r = 0.38; p = 0.04) as estimated by the ellipse area method. Median RAP(RHC) was significantly different between 3 subjective assessments of right atrial size (p = 0.037). Conclusions: Spectral Doppler assessments of tricuspid and pulmonic regurgitation are imperfect methods for predicting PAP as measured by catheterization despite an overall moderate correlation between invasive and noninvasive values. Noninvasive measurements may be better utilized as part of a comprehensive assessment of PAP in canine patients. RAP(RHC) appears best estimated based on subjective assessment of RA size. Including estimated RAP(ECHO) in estimates of PAP improves the correlation and relatedness between noninvasive and invasive measures of PAP, but notable variability in accuracy of estimations persists. (C) 2014 Elsevier B.V. All rights reserved.