Document Detail

A noninvasive algorithm to exclude pre-capillary pulmonary hypertension.
MedLine Citation:
PMID:  20693249     Owner:  NLM     Status:  MEDLINE    
Current guidelines recommend right heart catheterisation (RHC) in symptomatic patients at risk of pre-capillary pulmonary hypertension (PH) with echocardiographic systolic pulmonary artery pressures ≥ 36 mmHg. Growing awareness for PH, a high prevalence of post-capillary PH and the inability to distinguish between pre- and post-capillary PH by echocardiography have led to unnecessary RHCs. The aim of our study was to assess whether standard noninvasive diagnostic procedures are able to safely exclude pre-capillary PH. Data from 251 patients referred for suspicion of pre-capillary PH were used to develop a noninvasive diagnostic decision tree. A prospectively collected data set of 121 consecutive patients was utilised for temporal validation. According to the decision tree, patients were stratified by the presence or absence of an electrocardiographic right ventricular strain pattern (RVS) and serum N-terminal brain natriuretic peptide (NT-proBNP) levels below and above 80 pg·mL⁻¹. In the absence of RVS and elevated NT-proBNP, none of the patients in the prospective validation cohort were diagnosed with pre-capillary PH by RHC. Combining echocardiography with the diagnostic algorithm increased specificity to 19.3% (p = 0.0009), while sensitivity remained at 100%. Employing ECG and NT-proBNP on top of echocardiography helps recognise one false positive case per five patients referred with dyspnoea and echocardiographic suspicion of PH, while not missing true pre-capillary PH.
D Bonderman; P Wexberg; A M Martischnig; H Heinzl; M-B Lang; R Sadushi; N Skoro-Sajer; I M Lang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2010-08-06
Journal Detail:
Title:  The European respiratory journal     Volume:  37     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-02     Completed Date:  2011-08-31     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  1096-103     Citation Subset:  IM    
Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
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MeSH Terms
Cardiac Catheterization*
Cohort Studies
Electrocardiography / methods
Heart Ventricles / physiopathology,  ultrasonography
Hypertension, Pulmonary / diagnosis*,  physiopathology,  ultrasonography
Middle Aged
Natriuretic Peptide, Brain / blood
Prospective Studies
Retrospective Studies
Sensitivity and Specificity
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain
Comment In:
Eur Respir J. 2011 May;37(5):994-6   [PMID:  21532016 ]

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