quinta-feira, 19 de maio de 2011

O papel do Ecocardiograma na Hipertensão Pulmonar - by Fábio Soares

Falando em limitações do ecocardiograma... recomendo a leitura deste artigo, o qual enviei por e-mail a todos do grupo Ecobahia. E não deixem de ler o editorial, muito bem escrito em anexo.

Inaccuracy of Doppler Echocardiographic Estimates of Pulmonary Artery Pressures in Patients With Pulmonary Hypertension Implications for Clinical Practice

Jonathan D. Rich , MD ; Sanjiv J. Shah , MD ; Rajiv S. Swamy , MD ; Anna Kamp , MD ; and Stuart Rich , MD , FCCP

Background: Recent studies suggest that Doppler echocardiography (DE)-based estimates of pulmonary artery systolic pressure (PASP) may not be as accurate as previously believed. We sought to determine the accuracy of PASP measurements using DE compared with right-sided heart catheterization (RHC) in patients with pulmonary hypertension (PH). 

Methods: We compared DE estimates of PASP to invasively measure PASP during RHC in 160 consecutive patients with PH (part one). To account for possible changes in hemodynamics between DE and RHC, we then prospectively determined PASP in an additional 23 consecutive patients undergoing simultaneous RHC and DE (part two). Bland-Altman analyses were performed to evaluate the agreement between RHC and DE measurements of PASP. Accuracy was predefi ned as 95% limits of agreement within 6 10 mm Hg for PASP estimates.

Results: In part one, there was moderate correlation between DE and RHC measurements of  PASP ( r 5 0.68, P , .001). However, using Bland-Altman analysis, the bias for DE estimates of PASP was 2.2 mm Hg with 95% limits of agreement ranging from 2 34.2 to 38.6 mm Hg. DE estimates of PASP were determined to be inaccurate in 50.6% of patients. In part two, there was moderate correlation between DE and RHC measurements of PASP ( r 5 0.71, P , .01). However, despite simultaneous DE and RHC measurements, the bias for DE estimates of PASP was 8.0 mm Hg  with 95% limits of agreement ranging from 2 28.4 to 44.4 mm Hg.




Conclusions: DE estimates of PASP are inaccurate in patients with PH and should not be relied on to make the diagnosis of PH or to follow the effi cacy of therapy. CHEST 2011; 139(5):988–993

Trecho do editorial: O papel do Ecocardiograma na Hipertensão Pulmonar - O óbvio precisa ser provado

In Greek mythology, Echo (Greek, x ώ ; Ēkhō ; Sound ) is a mountain nymph who loves her own voice. Although it is indeed beautiful, the voice of echocardiography is insuffi cient as a solo instrument used in the diagnosis of PAH. Common sense and the obvious, as defi ned by Aristotle 2,300 years ago, still deserve our respect, particularly in the current era of rapidly increasing complexity in medicine and science.
Ian Paterson , MD ; Evangelos D. Michelakis , MD Edmonton, AB, Canada

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