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Diagnostic algorithm proposed for pulmonary hypertension.

SAN DIEGO -- Combining an electrocardiogram with serum N-terminal pro-B-type natriuretic peptide measurements is a simple, noninvasive way to diagnose pulmonary hypertension, results from an Austrian study suggest.

"Current pulmonary hypertension diagnosis guidelines say that ECG alone is not useful in the diagnosis of pulmonary hypertension," Dr. Diana Bonderman said in an interview at an international conference of the American Thoracic Society. "But if you combine ECG with NT-proBNP [N-terminal pro-B-type natriuretic peptide], it's going to be useful."

The finding is clinically important, she said, because the growing awareness of pulmonary hypertension (PH), a high prevalence of postcapillary PH, and the inability to discern between pre- and postcapillary PH by transthoracic echocardiography (TTE) "have led to unnecessary right heart catheterizations."

She and her associates prospectively analyzed data from 121 patients referred to the Medical University of Vienna between April 2007 and October 2008 for clinical and transthoracic echocardiographic suspicion of precapillary PH (systolic pulmonary artery pressure of 36 mm Hg or greater). On admission, all patients underwent TTE, serum analysis including NT-proBNP, a 6-minutc walk test, and blood gas analysis.

The patients were then assigned to one of two predicted diagnostic groups: precapillary PH (defined as right ventricular strain on ECG and/or serum NT-proBNP of greater than 80 pg/mL) or no precapillary PH. Next, all patients underwent right heart catheterization, and a final diagnosis was established.

The mean age of the patients was 62 years and 59% were female, reported Dr. Bonderman, a cardiologist at the Medical University of Vienna.

By right heart catheterization, only 64 (53%) patients were diagnosed with precapillary PH. Precapillary PH was ruled out in 57 (47%) patients. By the diagnostic algorithm, 15 patients (12%) had been correctly allocated to the group without precapillary PH (true negatives). None of the allocations was a false negative.

"In the diagnostic pathway of PH, integration of the proposed algorithm subsequent to TTE may increase specificity from 0% to 19.3%, with a sensitivity of 100%," the researchers wrote in their poster. "The incorporation of ECG and NT-proBNP into the workup of PH provides incremental diagnostic value and may significantly reduce the number of invasive assessments."

The researchers had no conflicts of interest to disclose.
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Author:Brunk, Doug
Publication:Internal Medicine News
Article Type:Clinical report
Geographic Code:1USA
Date:Sep 1, 2009
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