Imperial College London
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Dr Peter M George

Faculty of Medicine, National Heart & Lung Institute

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

p.george

 
 
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Location

 

Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Keir:2018:10.1111/resp.13250,
author = {Keir, GJ and John, Wort S and Kokosi, M and George, PM and Walsh, SLF and Jacob, J and Price, L and Bax, S and Renzoni, EA and Maher, TM and MacDonald, P and Hansell, DM and Wells, AU},
doi = {10.1111/resp.13250},
journal = {Respirology},
pages = {687--694},
title = {Pulmonary hypertension in interstitial lung disease: limitations of echocardiography compared to cardiac catheterization},
url = {http://dx.doi.org/10.1111/resp.13250},
volume = {23},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND AND OBJECTIVE: In interstitial lung disease (ILD), pulmonary hypertension (PH) is a major adverse prognostic determinant. Transthoracic echocardiography (TTE) is the most widely used tool when screening for PH, although discordance between TTE and right heart catheter (RHC) measured pulmonary haemodynamics is increasingly recognized. We evaluated the predictive utility of the updated European Society of Cardiology/European Respiratory Society (ESC/ERS) TTE screening recommendations against RHC testing in a large, well-characterized ILD cohort. METHODS: Two hundred and sixty-five consecutive patients with ILD and suspected PH underwent comprehensive assessment, including RHC, between 2006 and 2012. ESC/ERS recommended tricuspid regurgitation (TR) velocity thresholds for assigning high (>3.4 m/s), intermediate (2.9-3.4 m/s) and low (<2.8 m/s) probabilities of PH were evaluated against RHC testing. RESULTS: RHC testing confirmed PH in 86% of subjects with a peak TR velocity >3.4 m/s, and excluded PH in 60% of ILD subjects with a TR velocity <2.8 m/s. Thus, the ESC/ERS guidelines misclassified 40% of subjects as 'low probability' of PH, when PH was confirmed on subsequent RHC. Evaluating alternative TR velocity thresholds for assigning a low probability of PH did not significantly improve the ability of TR velocity to exclude a diagnosis of PH. CONCLUSION: In patients with ILD and suspected PH, currently recommended ESC/ERS TR velocity screening thresholds were associated with a high positive predictive value (86%) for confirming PH, but were of limited value in excluding PH, with 40% of patients misclassified as low probability when PH was confirmed at subsequent RHC.
AU  - Keir,GJ
AU  - John,Wort S
AU  - Kokosi,M
AU  - George,PM
AU  - Walsh,SLF
AU  - Jacob,J
AU  - Price,L
AU  - Bax,S
AU  - Renzoni,EA
AU  - Maher,TM
AU  - MacDonald,P
AU  - Hansell,DM
AU  - Wells,AU
DO  - 10.1111/resp.13250
EP  - 694
PY  - 2018///
SN  - 1323-7799
SP  - 687
TI  - Pulmonary hypertension in interstitial lung disease: limitations of echocardiography compared to cardiac catheterization
T2  - Respirology
UR  - http://dx.doi.org/10.1111/resp.13250
UR  - http://hdl.handle.net/10044/1/56082
VL  - 23
ER  -
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