Transthoracic Echocardiographic Overestimates Pulmonary Arterial Pressure in Women With Hypertension

pulmonary hypertension
Transthoracic echocardiography may overestimate pulmonary arterial pressure in multiple patient populations and cannot replace right heart catheterization as a confirmatory tool.

Transthoracic echocardiography (TTE) may overestimate pulmonary artery pressure (PAP) compared with right heart catheterization, particularly in women with hypertension and arrhythmia, as well as in patients receiving diuretic treatment. This is according to a study published in Heart, Lung and Circulation.

This retrospective, observational study included 141 consecutive patients with suspected or confirmed pulmonary hypertension from a single center. The mean age of the population was 63.6±11.5 years, and the majority were women (n=84). All patients included in the study underwent TTE and subsequent right heart catheterization within 3 hours. The investigators assessed the correlation between TTE and right heart catheterization in their ability to estimate systolic PAP (SPAP) and mean PAP (MPAP).

Out of the 124 patients who were eligible for the study, 106 patients had pulmonary hypertension diagnosed at right heart catheterization. Investigators found a moderate correlation between both SPAP (r=0.65) and MPAP (r=0.60) estimated by TTE in those assessed by right heart catheterization.

In the Bland-Altman analysis, there was a bias of -11.9 mmHg (95% limits of agreement, -45.4 to 121.5 mmHg) for SPAP estimation vs -4.6 mmHg (95% limits of agreement, -27.9 to 118.8 mmHg) for MPAP estimation. According to the researchers, this finding suggests a general overestimation of PAP using TTE.

The researchers also noted that the primary factors that contributed to the discrepancies between right heart catheterization and TTE were female gender, arrhythmic cardiac electrical activity, systemic arterial hypertension, and diuretic treatment with furosemide.

Limitations of the study included its retrospective nature, monocentric design, as well as the small number of patients in the final sample.

While the investigators concluded that the echocardiographic method is a valid screening tool for classifying PAP, “the echocardiographic measurements cannot replace [right heart catheterization], and should always be verified through the invasive approach, especially when important clinical decisions are required for prognostic purposes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sonaglioni A, Cassandro R, Luisi F, et al. Correlation between doppler echocardiography and right heart catheterisation-derived systolic and mean pulmonary artery pressures: Determinants of discrepancies between the two methods. Heart Lung Circ. Published online November 19, 2020. doi: 10.1016/j.hlc.2020.10.009