Role of echocardiography in evaluating patients with pulmonary hypertension secondary to congenital heart diseases in economically developing countries

Background: Right heart catheterization remains the gold standard to diagnose pulmonary hypertension in CHD patients. Availability and cost of catheterization are common problems in the developing world. Recent studies showed that echocardiography could be considered an alternative method to assess pulmonary hypertension because it is non-invasive, safe, and accessible. Objectives: This study aims to determine the diagnostic value of echocardiography in evaluating pulmonary hypertension in CHD patients. Method: This study was a cross-sectional study with a total of 48 CHD patients aged under 18 suspected of pulmonary hypertension, with 22 males and 26 females. The investigation was conducted in Dr. Cipto Mangunkusumo Hospital from January until December 2020. All subjects were initially assessed with echocardiography and then underwent right cardiac catheterization to confirm the diagnosis of pulmonary hypertension. The data were then recorded and analyzed. We estimated the sensitivity, specificity, and other diagnostic values while also performing Bland-Altman analysis to determine the agreement between echocardiography and catheterization. Results: The sensitivity and specificity of echocardiography in diagnosing pulmonary hypertension were 71.1% and 70%, respectively. Echocardiography showed a significant change in pre-test and post-test probability, which were 79.2% to 90%. There was a moderate correlation between the results of the two tests (rho: 0.38, p = 0.0077). The Bland-Altman analysis found -8.9 mmHg bias with 95% limits of agreement from -44.9 to 27.2 mmHg. Conclusion: Echocardiography shows a considerable diagnostic capacity in determining pulmonary hypertension, although it remains inferior to cardiac catheterization. Echocardiography should be considered as an alternative method in screening and diagnosing pulmonary hypertension.