title: Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension.
abstract: OBJECTIVE
  Early, preferably noninvasive, detection of pulmonary hypertension improves prognosis. Our study evaluated the diagnostic accuracy of the electrocardiographically derived Butler-Leggett (BL) score and ventricular gradient (VG) to estimate mean pulmonary artery pressure (PAP).
  
  
  METHODS
  In 63 patients with suspected pulmonary hypertension, BL score and VG were calculated. The VG was projected on a direction optimized for detection of right ventricular pressure overload (VG-RVPO). BL score and VG-RVPO were entered in multiple linear regression analysis and the diagnostic performance to detect PH (invasively measured mean PAP ≥ 25 mmHg) was assessed with receiver operating characteristic analysis.
  
  
  RESULTS
  Both BL score and VG-RVPO correlated significantly with mean PAP (r=0.45 and r=0.61, respectively; P<0.001). Combining BL score and VG-RVPO increased the correlation to 0.67 (P<0.001). The diagnostic performance of this combination for the detection of PH was good with an area under the curve of 0.79 (P<0.001).
  
  
  CONCLUSIONS
  Combination of the BL score and VG-RVPO allows for accurate detection of increased PAP.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Kamphuis
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Marlieke L A
authors.initials: ML
authors.lastname: Haeck
authors.affiliation: Department of Cardiology, Duke University, NC, USA.
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Arie C
authors.initials: AC
authors.lastname: Maan
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, The Netherlands. Electronic address: c.a.swenne@lumc.nl.
authors.forename: Cees A
authors.initials: CA
authors.lastname: Swenne
mesh_terms: D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017725:Ventricular Pressure
keywords: Electrocardiogram; Pulmonary hypertension; Right ventricular pressure overload; Ventricular gradient