Echocardiography Findings for Pulmonary Hypertension During Workup for Bronchoscopic Lung Volume Reduction

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive intervention that improves dyspnea and quality of life in select individuals with emphysema. Echocardiography is the initial screening tool for pulmonary hypertension (PH) in patients evaluated for BLVR. Multiple BLVR and lung volume reduction surgery (LVRS) trials have used and right ventricular systolic pressure (RVSP) of 45 mm Hg as a cutoff for potential significant PH. However, PH is established hemodynamically by right heart catheterization (RHC), not echocardiography due to notoriously inaccurate RSVP values in patients with lung disease, especially those with COPD and suboptimal acoustic imaging windows. Over a 5-year period, all patients who met PFT criteria for BLVR underwent a routine screening echocardiogram for PH. Twenty-four patients with a RVSP >45 mm Hg or suspicion of significant PH on echocardiography were subjected to RHC. Twenty-one (88%) with suspicion for significant PH based on echocardiography did not have significant PH on RHC. Three patients (12%) had significant PH based on RHC precluding them from BLVR. Ten of the 21 patients with echo suspected PH, but RHC negative PH qualified for BLVR. Twelve-month follow-up data was available for 7 of these patients post-BLVR that included change in forced expiratory volume in 1 second (FEV1), 6-minute walk distance (6MWD), and St. George's Respiratory Questionnaire (SGRQ). The mean change in FEV1 showed an increase of 0.154 L, 6MWD increase of 42 m, and SGRQ decrease of 11.5 points. On the basis of results from this study, all patients being evaluated for BLVR found to have a RVSP over 45 mm Hg on echocardiography should undergo RHC to confirm significant PH.