Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy.
The respective value of four non-invasive methods for the diagnosis of pulmonary arterial hypertension (PAH) was investigated in 63 COPD patients, using right heart catheterization as the reference method: 22 patients had no resting PAH (pulmonary artery mean pressure (PAP) less than or equal to 20 mmHg); 26 patients had mild PAH (PAP = 21-30 mmHg); and 15 patients had moderate to severe PAH (PAP greater than 30 mmHg). The specificity of ECG was 86% and the sensitivity 51% (only 38% in mild PAH). The specificity of radiological measurements was 63% and the sensitivity 46% (38% in mild PAH). Echocardiography (echo) had the best results with a specificity of 75% and a sensitivity of 78% (73% in mild PAH), but reliable echo measurements were available in only 52 out of 63 patients. Myocardial scintigraphy had a specificity of 68% and a sensitivity of 66% (58% in mild PAH). A stepwise regression analysis (including one echo, one ECG, one radiological and one functional variable) explained only 43% of the variance of PAP (multiple r = 0.66). These results suggest that no individual method is sufficiently reliable for predicting the presence of PAH, and particularly mild PAH, but the combination of echo + myocardial scintigraphy allows the prediction of PAH with a good probability. The precise level of PAH cannot be estimated, even when using multiple regression equations.
Pulmonary Function Laboratory, University Hospital, Strasbourg, France.
M
M
Oswald-Mammosser
T
T
Oswald
E
E
Nyankiye
M C
MC
Dickele
D
D
Grange
E
E
Weitzenblum
D000328:Adult; D000368:Aged; D004452:Echocardiography; D004562:Electrocardiography; D006321:Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008173:Lung Diseases, Obstructive / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests