Right ventricular dysfunction compromises accuracy of echocardiographic diagnosis of pulmonary hypertension in heart failure.

BACKGROUND: The Swan-Ganz catheter and echocardiography (ECHO) are commonly used to measure pulmonary artery systolic pressure. It is unknown how right ventricular dysfunction influences the accuracy of ECHO-derived estimation of pulmonary hypertension in patients with severe left ventricular systolic dysfunction. METHODS AND
RESULTS: We analyzed a limited-access dataset from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial provided by the National Heart, Lung, and Blood Institute. Patients enrolled in this trial had left ventricular ejection fraction <30% and decompensated heart failure (HF). Preserved and depressed right ventricular function was defined as fractional area change ≥30% and <30%, respectively. Pearson correlation coefficient, sensitivity, and specificity were calculated. In 106 patients, there were serial measurements of pulmonary artery systolic pressure with both Swan-Ganz catheter and ECHO. For all points of time, including admission for HF decompensation, next day (subcompensation), and the last day of hemodynamic measurements (compensation), correlation was better for preserved than for depressed right ventricular function.
CONCLUSIONS: Accuracy of echocardiographic estimation of pulmonary hypertension in patients with systolic HF is better when right ventricular systolic function is preserved.