Pulmonary arterial hypertension (PAH) in patients with congenital heart disease (CHD) is associated with increased morbidity and mortality. While Doppler echocardiography(DE) has been a useful screening test in PAH，the presence of structural cardiac defects may affect the ability to reliably predict systolic pulmonary arterial pressure (sPAP)．Therefore, the aim of this study was to analyze the reliability of noninvasive PAP assessment by Doppler echocardiography compared to invasive measurements in a large atrial septal defect (ASD) patient population.
We retrospectively analyzed data from a large tertiary cardiology department over 2 years. Relationships between RHC- and DE-derived hemodynamics were assessed using the Pearson correlation. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of sPAP.
763 ASD patients (mean age 32.8±19.4 years, 542 [71%] female gender) who underwent DE and right heart catheterization (RHC) examinations. A significant overestimation of the sPAP, sPAP was 43.8±13.4 mm Hg by DE and 37.8±11.8 mm Hg by RHC(P<0.001). There was moderate correlation between DE and RHC measurements of PASP (r = 0.501, P<0.001). Bland–Altman analysis showed a bias of 6.1 mm Hg for sPAP (95% limits of agreement -18.2 to +30.4 mm Hg).
DE estimates of sPAP are overestimation in patients with ASD and should not be relied on to make the diagnosis of PAH.