Doppler echocardiography-right heart catheterization relationships in patients with idiopathic pulmonary fibrosis and suspected pulmonary hypertension.

BACKGROUND

Pulmonary hypertension occurs commonly in patients with interstitial lung disease but is frequently not diagnosed or, if diagnosed, not further evaluated. In this study, we wanted to determine the accuracy of right ventricular systolic pressure measured by transthoracic Doppler echocardiography compared with hemodynamic measurements taken at right heart catheterization in patients with idiopathic pulmonary fibrosis who had suspected pulmonary hypertension.

MATERIAL/METHODS: Right heart catheterization was conducted if pulmonary hypertension was suggested by echocardiography-right ventricular systolic pressure >40 mm Hg. Pulmonary hypertension was defined by right heart catheterization as mean pulmonary artery pressure > or =25 mm Hg and pulmonary artery occlusion pressure < or =15 mm Hg.

RESULTS

Right heart catheterization demonstrated pulmonary hypertension in 75% while no pulmonary hypertension was confirmed in 12%. Correlations existed between right ventricular systolic pressure with pulmonary artery systolic pressure (r=0.66; p<0.0001) and mean pulmonary artery pressure (r=0.69; p<0.0001). Bland-Altman analysis illustrated the mean difference between the two methods was 7.75 mm Hg.

CONCLUSIONS

Pulmonary hypertension occurs commonly in IPF. Accurate classification of pulmonary hemodynamics and degree of pulmonary hypertension severity require right heart catheterization. Prospective screening Doppler echocardiography and pulmonary hypertension therapeutic interventions warrant further prospective study in idiopathic pulmonary fibrosis.