[Use of echocardiography in the diagnosis of pulmonary hypertension].

There are few data regarding the sensitivity and specificity of the pulmonic valve echogram in the detection of pulmonary hypertension (PHT). In the present study, simultaneous pulmonic echograms were evaluated in 40 patients with normal pulmonary artery pressure and 24 with PHT (mean pressure greater than 20 mmHg). The A wave depth (Amax) was 4.0 plus or minus 1 mm (2-6 mm) in normals but was (1.05 plus or minus 0.2 mm) (p less than 0,001) in PHT and was absent in 5 of 24 PHT patients with a mean pulmonary artery pressure (MPAP) greater than or equal to 35 mm. The ef slope in normals was 22 plus or minus 1.8 mm and 7.1 plus or minus 2 mm (p less than 0.01) in patients with PHT. A negative slope was observed in 4 patients with severe PHT (MPAP) greater than or equal to 40 mm, but never in normals or in patients with mild PHT. The opening velocity (OV) was significantly higher in PHT patients 363.2 plus or minus 19.3 verus 293 plus or minus 7.3 mm/sec (p less than 0.01). Normal values were found in patients with moderate to severe PHT but an OV greater than or equal to 450 mm/sec was not encountered within the normal group. A mid-systolic notch was observed in 10 patients with PHT of which 9 with a MPAP greater than or equal to 35 mmHg. The maximum systolic excursion of the pulmonary valve in both groups did not differ significantly (13.3 plus or minus 0.5 vs 12.8 plus or minus 0.3). Even less specific, the systolic intervals (PEP/ET), were raised greater than or equal to 0.30 in 12 out of 15 with PHT. In conclusion, the reduction or disappearance of Amax with sinus rhythm, a flattening or negativation of ef slope and the presence of a mid-systolic notch were found to be the 3 most reliable criteria to detect and quantify PHT.