title: Use of ECG and Other Simple Non-Invasive Tools to Assess Pulmonary Hypertension.
abstract: BACKGROUND
  There is a broad consensus that pulmonary hypertension (PH) is to be diagnosed by right heart catheterization (RHC) and that the most important non-invasive tool is echocardiography. However, the role of simple non-invasive tools in the work-up of PH is not clearly defined. We hypothesized that the use of simple non-invasive techniques may help to guide important decisions in the diagnostics of pulmonary hypertension.
  
  
  OBJECTIVE
  We aimed to develop an algorithm with the use of simple, non-invasive tools in order to identify patients with very high or very low likelihood of PH.
  
  
  METHODS
  We retrospectively analyzed all consecutive patients undergoing RHC between 2005 and 2010 in our center and performed logistic regression of simple non-invasive parameters regarding detection and exclusion of PH and derived a two-step algorithm. In a prospective study we evaluated this algorithm between 2011 and 2013.
  
  
  RESULTS
  The retrospective cohort consisted of n = 394 patients of which 49% presented with PH. Right axis deviation in the ECG was present in 90/394 patients and had a positive predictive value (PPV) of 93% for PH. The combination of non-right axis deviation, N-terminal pro brain natriuretic peptide (NT-proBNP)<333pg/ml, arterial oxygen saturation (SO2)≥95.5% and WHO functional class I-II was present in 69/394 patients and excluded PH with a negative predictive value (NPV) of 96%. The prospective study confirmed these results in a cohort of n = 168 patients (PPV:92%, NPV:97%). Taken together, simple non-invasive tools allowed a prediction regarding the presence or absence of PH in 42% of patients with suspected PH.
  
  
  CONCLUSIONS
  ECG, NT-proBNP, SO2 and WHO functional class may predict the presence or absence of PH in almost half of the patients with suspected PH, suggesting an important role for these variables in the work-up of patients at risk for PH.
  
  
  BACKGROUND
  NCT01607502.
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.|Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
authors.forename: Gabor
authors.initials: G
authors.lastname: Kovacs
authors.affiliation: Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.|Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Avian
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.|Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
authors.forename: Vasile
authors.initials: V
authors.lastname: Foris
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.|Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Tscherner
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.
authors.forename: Xhylsime
authors.initials: X
authors.lastname: Kqiku
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.|Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Douschan
authors.affiliation: Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bachmaier
authors.affiliation: Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.|Medical University of Graz, Institute for Physiology, Graz, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Olschewski
authors.affiliation: Department of Biomedicine, Division of Rheumatology, AOUC and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Pulmonology, Graz, Austria.|Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
authors.forename: Horst
authors.initials: H
authors.lastname: Olschewski
mesh_terms: D000465:Algorithms; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment