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A noninvasive algorithm to exclude pre-capillary pulmonary hypertension.

D Bonderman1, P Wexberg, A M Martischnig

  • 1Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. diana.bonderman@meduniwien.ac.at

The European Respiratory Journal
|August 10, 2010
PubMed
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Standard noninvasive tests, including ECG and NT-proBNP, can safely exclude pre-capillary pulmonary hypertension (PH) in symptomatic patients, reducing unnecessary right heart catheterisations.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Diagnostic Imaging

Background:

  • Current guidelines recommend right heart catheterisation (RHC) for symptomatic patients with echocardiographic systolic pulmonary artery pressures ≥ 36 mmHg at risk of pre-capillary pulmonary hypertension (PH).
  • Increased PH awareness, high post-capillary PH prevalence, and echocardiography's limitations in differentiating PH types lead to unnecessary RHC procedures.

Purpose of the Study:

  • To evaluate the safety and efficacy of standard noninvasive diagnostic procedures in excluding pre-capillary PH.
  • To develop and validate a noninvasive diagnostic decision tree for pre-capillary PH.

Main Methods:

  • A noninvasive diagnostic decision tree was developed using data from 251 patients suspected of having pre-capillary PH.
  • The decision tree stratified patients based on electrocardiographic right ventricular strain (RVS) pattern and serum NT-proBNP levels (<80 pg·mL⁻¹).

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  • Temporal validation was performed on a prospective cohort of 121 consecutive patients.

    • Main Results:

    • In the validation cohort, no patients without RVS and with NT-proBNP <80 pg·mL⁻¹ were diagnosed with pre-capillary PH via RHC.
    • Combining echocardiography with the noninvasive algorithm demonstrated 100% sensitivity and increased specificity to 19.3% (p = 0.0009).
    • The algorithm correctly identified one false positive case per five patients with suspected PH, while accurately identifying true pre-capillary PH.

    Conclusions:

    • Electrocardiography (ECG) and NT-proBNP, alongside echocardiography, can safely exclude pre-capillary PH.
    • This noninvasive approach can significantly reduce the number of unnecessary RHCs in patients with suspected PH.
    • Implementing this diagnostic algorithm improves diagnostic accuracy and patient management for suspected pulmonary hypertension.