Pulmonary hypertension in advanced lung diseases: Echocardiography as an important part of patient evaluation for lung transplantation

IntroductionPulmonary hypertension (PH) is common complication in advanced lung disease. Echocardiography provides additional information and may be useful to assess PH probability. ObjectivesThe usefulness of combination of well-known echocardiographic parameters in detecting PH in patients with advanced lung disease referred for lung transplantation was evaluated. MethodsThe study population consisted of 37 consecutive patients with idiopathic pulmonary fibrosis (IPF), 20 patients with chronic obstructive pulmonary disease (COPD), and 8 patients with other interstitial lung diseases. PH was defined as mean pulmonary arterial pressure (mPAP) 25 mm Hg diagnosed by cardiac catheterization. ResultsPH was present in 67.6% of enrolled IPF patients, 30% of enrolled COPD patients, and 75% of patients with other interstitial lung diseases. The receiver operating characteristics (ROC) curve analysis demonstrated right ventricular systolic pressure (RVSP) 43 mm Hg to be the threshold for PH prediction (n=37, sensitivity 92.3%, specificity 81.8%, area under curve (AUC) 0.84, 95% confidence interval (CI) 0.67-1.0; P = .019). Right ventricular outflow tract (RVOT) diameter 34 mm and tricuspid annular plane systolic excursion (TAPSE) 18 mm had acceptable sensitivity, specificity and AUC (n=65, 62.2%, 89.3%, 0.77, 95% CI 0.66-0.89; P = .11 and n=62, 77.1%, 66.7%, 0.74, CI 0.61-0.87; P = .27, respectively). Combination of RVSP, RVOT and TAPSE, obtained in 36 patients, increased the sensitivity and negative predictive value (NPV) to 100%. ConclusionsIn patients with advanced lung diseases referred for lung transplantation the combination of RVSP, RVOT diameter, and TAPSE may be helpful in PH exclusion.