title: Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension.
abstract: Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH.300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R(2)=0.66 and area under the curve 0.93. In patients with a risk score ≥72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases.
authors.affiliation: Dept of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands Dept of Pulmonology, Martini Hospital, Groningen, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Jacobs
authors.affiliation: Dept of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Thelma C
authors.initials: TC
authors.lastname: Konings
authors.affiliation: Dept of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Dept of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Anco
authors.initials: A
authors.lastname: Boonstra
authors.affiliation: Dept of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Harm Jan
authors.initials: HJ
authors.lastname: Bogaard
authors.affiliation: Dept of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: Dept of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands a.vonk@vumc.nl.
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk Noordegraaf
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors