Author's reply.

Sir,

Dr. Yalcinkaya[1] pointed out a very important concept for the limitation of 2 dimentional echocardiography (2D) in the assessment of RV function and morphology. Such limitation forced all guidelines to consider the right heart catheterization (RHC) as the standard technique for the accurate assessment of right ventricular function in patients with pulmonary hypertension (PH).

A number of studies addressed the issue of reliability of Doppler echocardiography in detecting and quantifying PH. TR jets are analyzable in 39 to 86% of patients.[23] The variability points out that technical and operator factors can affect the usefulness of this test. In a cohort study of 374 lung-transplant candidates,[4] the accuracy of echocardiography compared with RHC in the determination of systolic pulmonary artery pressure (sPAP) and diagnosis of PH were investigated. The prevalence of PH was 25% in the study population. Estimation of sPAP by echocardiography was achieved in 166 patients (44%). However, 52% of pressure estimations were found to be inaccurate (more than 10 mm Hg difference compared with measured pressure), and 48% of patients were misclassified as having PH by echocardiography. Sensitivity, specificity, and positive and negative predictive values of sPAP estimation for diagnosis of PH were 85, 55, 52, and 87%, respectively. Because of these limitations, combined parameters projections other than sPAP have been used to improve echocardiographic accuracy for diagnosing and assessing the severity of PH. These include tricuspid annular plane systolic excursion (TAPSE), pre-ejection period, acceleration and deceleration, relaxation, and contraction times.[5-7] However, most of these parameters were used clinically in a setting of chronic PH and, to our knowledge, there is no data to test their usefulness and accuracy in conditions leading to acute PH, such as pulmonary embolism.

In our case series,[8] we tried to enhance the accuracy of 2D echo results by using both quantitative and qualitative criteria.

Acknowledging the points raised by Dr. Yalcinkaya, we believe that further studies are needed before adopting combined parameters projections for the assessment of RV function in acute setting of PH.