A comparison of echocardiography and pulmonary artery catheterization for evaluation of pulmonary artery pressures in pregnant patients with suspected pulmonary hypertension

OBJECTIVE: This study was undertaken to compare the accuracy of echocardiog raphy versus pulmonary artery catheterization to estimate pulmonary artery pressures in pregnant women with suspected pulmonary hypertension. STUDY DESIGN: A retrospective chart review was performed between January 19 90 and February 2000 for all pregnant patients with cardiac disease. Patien ts with pulmonary artery pressure values estimated by cardiac catheterizati on and echocardiography during pregnancy were included. Pulmonary hypertens ion is defined as pulmonary artery systolic pressure > 30 mm Hg. RESULTS: Twenty-seven patients were included in the study. There was a sign ificant overestimation of the mean pulmonary artery pressure with echocardi ography compared with catheterization (55.4 vs 51.1 mm Hg; P < .005). Of th e 20 patients, pulmonary artery pressure was significantly greater when est imated by echocardiography than when measured by catheterization (59.6 vs 5 4.8 mm Hg; P < .004). Thirty-two percent (8/25) of the patients had pulmona ry hypertension when estimated by echocardiography but had normal pulmonary artery pressures on subsequent catheterization. CONCLUSION: Echocardiography significantly overestimated pulmonary artery p ressures compared with catheterization in pregnant patients with suspected pulmonary hypertension. Patients with structural cardiac defects appear to have a significantly greater difference in pulmonary artery pressures. Thir ty-two percent of pregnant patients with normal pulmonary artery pressures may be misclassified as having pulmonary artery hypertension when measured by echocardiography alone.