Letter by Farmakis and Aessopos Regarding Article, “Echocardiographic Markers of Elevated Pulmonary Pressure and Left Ventricular Diastolic Dysfunction Are Associated With Exercise Intolerance in Adults and Adolescents With Homozygous Sickle Cell Anemia in the United States and United Kingdom”

To the Editor: The interesting study by Sachdev et al,1 published recently in Circulation , stresses the indisputable value of echocardiography as a widely available and inexpensive tool for the screening of patients with sickle cell disease for cardiac dysfunction and pulmonary hypertension (PH). The final diagnosis of PH and the decision for treatment should always be based on right heart catheterization, as also suggested by the same authors, because echocardiography may overestimate pulmonary artery pressure, particularly in patients with anemia and thus compensatory high-output state.2 In this context, the appropriate thresholds of …