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Interstitial Lung Disease: IPF


Monday, October 22, 2007

10:30 AM - 12:00 PM

ECHOCARDIOGRAPHY AS A PREDICTOR OF PULMONARY HYPERTENSION IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS

Steven D. Nathan, MD*, Rajeev Saggar, MD, Scott Barnett, PhD, John A. Belperio, MD, Shahzad Ahmad, MD, David J. Ross, MD, Oksana A. Shlobin, MD, Rajan Saggar, MD, Eric Libre, MD, Joseph P. Lynch, III, MD and David A. Zisman, MD

Inova Fairfax Hospital, Vienna, VA

PURPOSE: Pulmonary hypertension (PH) frequently complicates the course and impacts the outcomes of patients with IPF. We sought to evaluate the utility of the right ventricular systolic pressure (RVSP) obtained by echocardiogram (echo) as a screen for PH and as a surrogate for the Pulmonary Artery systolic pressure (PASPcath) obtained by right heart catheterization (RHC).

METHODS: Retrospective review of IPF patients from two large tertiary centers.

RESULTS: Results: There were 110 patients who had both RHC and echo performed. Echo estimates of RVSP were obtained in 60 of the patients (54.5%) of whom 22 (36.6%) had PH, while 16 of the 50 patients without echo estimates (32%) had PH. The mean time between the RHC and echo was 32 days (range:0-226 days). The performance characteristics of echo as a screen for PH is shown in the Table. There were 24/60 (40%) echos that accurately reflected the PASP using a definition of accuracy as a RSVP to PASPcath difference of +/-10mmHg. 29/60 (48.3%) echos overestimated PASPcath , while 7/60 (11.6%) underestimated the PASPcath.In 32 of the cases, the echos were within one month of the RHC. The mean difference between the RSVP and PASPcath in these cases was also 8 mmHg (Range:-23 mmHg to +29mmHg). Only 12/32 (37.5%) of these cases fell within the range of accuracy.

CONCLUSION: Echo does not provide an accurate measure of the RSVP and is not a good screening tool for PH in patients with IPF.

CLINICAL IMPLICATIONS: If PH is being considered or sought in patients with IPF, echo alone does not suffice and other tests such as a right heart catheterization should be considered.

DISCLOSURE: Steven Nathan, No Financial Disclosure Information; No Product/Research Disclosure Information






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