Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension
Vasiliki Kalliopi Bournia,
Iraklis Tsangaris,
Loukianos Rallidis,
Dimitrios Konstantonis,
Frantzeska Frantzeskaki,
Anastasia Anthi,
Stylianos E. Orfanos,
Eftychia Demerouti,
Panagiotis Karyofillis,
Vassilis Voudris,
Katerina Laskari,
Stylianos Panopoulos,
Panayiotis G. Vlachoyiannopoulos,
Petros P. Sfikakis
Affiliations
Vasiliki Kalliopi Bournia
First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Iraklis Tsangaris
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Loukianos Rallidis
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Dimitrios Konstantonis
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Frantzeska Frantzeskaki
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Anastasia Anthi
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Stylianos E. Orfanos
Pulmonary Hypertension Clinic, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Eftychia Demerouti
Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece
Panagiotis Karyofillis
Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece
Vassilis Voudris
Invasive Cardiology Department, Onassis Cardiac Surgery Center, 176 74 Kallithea, Greece
Katerina Laskari
First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Stylianos Panopoulos
First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Panayiotis G. Vlachoyiannopoulos
Department of Pathophysiology and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Petros P. Sfikakis
First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece
Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic PASP deterioration with 59% sensitivity, 85% specificity, and 63/83% positive/negative predictive value, respectively. In multivariate analysis, successful echocardiographic prediction correlated only with higher PVR in previous catheterization (p = 0.05, OR = 1.235). Notably, in patients having baseline PVR > 5.45 WU, echocardiography had both sensitivity and positive predictive values of 73%, and both specificity and negative predictive value of 91% for detecting hemodynamic PASP deterioration. In selected patients with CTD-PAH echocardiography can predict PASP deterioration with high specificity and negative predictive value. Additional prospective studies are needed to confirm that better patient selection can increase the ability of standard echocardiography to replace repeat catheterization.
