Internal Medicine Journal Club

ARS (opens in new window) - Proxy me

1. What is the sensitivity and specificity of transthoracic echocardiogram in detecting pulmonary artery systolic pressures above 35 mm Hg?

• PIER - Disease: Pulmonary Hypertension > Diagnosis
  • Currie PJ, Seward JB, Chan KL, Fyfe DA, Hagler DJ, Mair DD, et al. Continuous wave Doppler determination of right ventricular pressure: a simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol. 1985;6:750-6. PMID: 4031289
    • Use PubMed's see related to find: Lanzarini L, Fontana A, Lucca E, Campana C, Klersy C. Noninvasive estimation of both systolic and diastolic pulmonary artery pressure from Doppler analysis of tricuspid regurgitant velocity spectrum in patients with chronic heart failure. Am Heart J. 2002;144:1087-94. PMID: 1248643
      • Sn=89%; sp=84% (but only 6 patients had normal PASP by cath)
      • 
• UpToDate - 'Clinical manifestations and diagnosis of secondary pulmonary hypertension'
  • Defines PHTN as " mean pulmonary artery pressure exceeds 25 mmHg at rest or 30 mmHg with exercise "
  • Berger, M, Haimowitz, A, Van Tosh, A, et al. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985; 6:359. PMID- 4019921
    • Use PubMed's see related to find: Lanzarini L et al (see above). PMID: 1248643
      • Use PubMed's see related to find: Lanzarini L, Fontana A, Campana C, Klersy C. Two simple echo-Doppler measurements can accurately identify pulmonary hypertension in the large majority of patients with chronic heart failure. J Heart Lung Transplant. 2005;24:745-54. PMID: 15949736
        • Defines PHTN as "(defined as pulmonary artery systolic pressure >35 mm Hg and
          mean pulmonary artery pressure >20 mm Hg);"
• SUMSearch
  • Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. European Society of Cardiology (note)- Medical Specialty Society.  2004.  36 pages.  NGC:004058
    • " PAH is defined by a mean PAP >25 mmHg at rest or >30 mmHg with exercise, by a PWP <15 mmHg, and by PVR >3 mmHg/L/min (Wood units). "
    • " In asymptomatic subjects (NYHA class I) a concomitant CTD should be excluded and echocardiography should be repeated in six months. "
    • McQuillan BM, Picard MH, Leavitt M, Weyman AE. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104:2797-802.
      PMID: 11733397
      • 28% of patients with otherwise normal echocardiograms had PASP>30mm Hg