title: Accuracy of chest radiography in predicting pulmonary hypertension: a case-control study.
abstract: OBJECTIVE
  To assess the accuracy of chest radiography (CXR) in predicting pulmonary hypertension (PH).
  
  
  METHODS
  We studied 108 consecutive patients with suspected PH who underwent right heart catheterization (RHC). All were PH treatment naives. Hemodynamic criteria included a mean pulmonary artery pressure >25 mmHg at rest, and a mean pulmonary wedge pressure <15 mmHg. Postero-anterior and lateral CXR were obtained shortly before RHC. To avoid a selection bias which could be introduced by examining only patients with suspected PH, we included in the analysis the CXR of 454 additional patients with different diagnosis: 57 with left heart failure (LHF) and pulmonary venous hypertension at RHC, 197 with chronic obstructive pulmonary disease, and 200 non-obstructed controls. CXR were examined independently by 4 raters, who were blinded to clinical, hemodynamic, and spirometric data. The diagnosis of PH was made if a prominent main pulmonary artery was associated with anyone of: isolated enlargement of right ventricle, right descending pulmonary artery >16 mm in diameter, pruning of peripheral pulmonary vessels.
  
  
  RESULTS
  Eighty-two patients had PH confirmed at RHC. Weighted sensitivity of CXR was 96.9% (95% confidence interval, 94.9 to 98.2%), and weighted specificity 99.8% (95% confidence interval, 99.6 to 99.9%). By considering the 165 patients who underwent RHC, weighted sensitivity of CXR was unchanged, and weighted specificity decreased to 99.1%. None of the patients with PH were misclassified as having LHF, and vice versa.
  
  
  CONCLUSIONS
  CXR is accurate in predicting PH. It may aid clinicians in selecting patients with suspected PH for hemodynamic ascertainment.
authors.affiliation: Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Italy (MM). Electronic address: massimo.miniati@unifi.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Miniati
authors.affiliation: Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy (SM, BF); Fondazione CNR-Regione Toscana "Gabriele Monasterio", Pisa, Italy (SM, BF, CB, CM).
authors.forename: Simonetta
authors.initials: S
authors.lastname: Monti
authors.affiliation: Azienda Sanitaria Locale (ASL) 5, Toscana, Italy (EA, RP).
authors.forename: Edoardo
authors.initials: E
authors.lastname: Airò
authors.affiliation: Azienda Sanitaria Locale (ASL) 5, Toscana, Italy (EA, RP).
authors.forename: Roberta
authors.initials: R
authors.lastname: Pancani
authors.affiliation: Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche (CNR), Pisa, Italy (SM, BF); Fondazione CNR-Regione Toscana "Gabriele Monasterio", Pisa, Italy (SM, BF, CB, CM).
authors.forename: Bruno
authors.initials: B
authors.lastname: Formichi
authors.affiliation: Fondazione CNR-Regione Toscana "Gabriele Monasterio", Pisa, Italy (SM, BF, CB, CM).
authors.forename: Carolina
authors.initials: C
authors.lastname: Bauleo
authors.affiliation: Fondazione CNR-Regione Toscana "Gabriele Monasterio", Pisa, Italy (SM, BF, CB, CM).
authors.forename: Carlo
authors.initials: C
authors.lastname: Marini
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000379:methods / Q000592:standards*
keywords: Chest radiography; Diagnosis; Pulmonary hypertension; Right heart catheterization