Effectiveness of echocardiographic evaluation of lung transplant candidates: Could it be an alternative to right heart catheterization?

Background: In this study, we aimed to evaluate the value of transthoracic echocardiography in the estimation of pulmonary artery pressure and to identify the presence of pulmonary hypertension in lung transplant candidates with end-stage lung disease.

Methods: Between January 2012 and September 2020, a total of 244 patients (166 males, 78 females; mean age: 48.6±13.8 years; range, 18 to 77 years) who were diagnosed with end-stage lung disease due to various underlying conditions and underwent right heart catheterization and transthoracic echocardiography within 72 h were retrospectively analyzed. Hemodynamic parameters of the patients were compared. Correlation analysis was performed among the values estimated by transthoracic echocardiography and measured by right heart catheterization for pulmonary artery pressure measurements.

Results: The median pulmonary artery systolic pressure with right heart catheterization was 43 mmHg and 40 mmHg using transthoracic echocardiography. A positive correlation was seen between the pulmonary artery systolic pressure estimated by transthoracic echocardiography and right heart catheterization (r=0.718; p<0.001). The sensitivity, specificity, and positive and negative predictive values of pulmonary artery systolic pressure measurement were 76.30%, 64.22%, 72.54%, and 68.63%, respectively.

Conclusion: This study revealed a strong positive correlation between the pulmonary artery systolic pressure evaluated with transthoracic echocardiography and measured with right heart catheterization. Pulmonary hypertension detection by these two methods showed acceptable sensitivity and specificity. Transthoracic echocardiography may be a useful and practical method to monitor pulmonary artery pressure trends both initially and in the subsequent follow-up of cardiac hemodynamics in lung transplant candidates.