DOI: 10.5176/2345-7201_1.1.01
Authors: Yasir Akhtar and Elisabeth von der Lohe
Abstract:
Severe pulmonary hypertension is prevalent as high as 29{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} in patient with severe aortic stenosis and significantly increases morbidity and mortality in these patients (1). Early Aortic Valve Replacement (AVR) for this high-risk subset of patients with Aortic Stenosis (AS) has been recommended (1).The etiology of Pulmonary Hypertension (PHT) in severe AS remains unclear however left ventricular (LV) dysfunction may be of one important etiology (2). Prior to AVR all patients undergo coronary angiography but hemodynamic cardiac catheterization is performed in minority of patients, consistent with current practices (3). Transthoracic echocardiography (TTE) is relied upon to measure the pulmonary artery systolic pressure using the modified Bernoulli equation(ref). However, this may not accurately assess the right ventricular systolic pressure in some cases due to suboptimal tracing of the regurgitation jet, decreased tricuspid jet velocity due to high right atrial pressure or poor estimation of right atrial pressures, and generally poor technique for several reasons (4). Correlations between echo-derived right ventricular pressure and measured pulmonary artery systolic pressure (PASP) by right heart catheterization (RHC) have been reported to be poor when assessed in patients with pulmonary disease (5, 6). No studies have compared echocardiographic assessment of PHT in AS with invasively obtained pulmonary artery pressure using RHC. The reliability of echocardiographic detection and degree of PHT in patients with AS is unknown. The gold standard for diagnosing PHT has been RHC. At our center, we perform hemodynamic measurements on all patients with aortic stenosis planning to undergo valve replacement. We report the unreliability of echocardiographic measurements when assessing for degree of stenosis and PHT.
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