Abstract 3152: Electrocardiography and Serum N-terminal Brain Natriuretic Peptide for Diagnostic Decision Making in Pulmonary Hypertension
Background. Current diagnosis guidelines for precapillary pulmonary hypertension (PH) recommend right heart catheterization (RHC) in patients with echocardiographic systolic pulmonary pressures (sPAP) 336mmHg. The growing awareness for PH, a high prevalence of postcapillary PH and the inability to discern between pre- and postcapillary PH by transthoracic echocardiography (TTE), have led to an excessive amount of RHCs in unaffected individuals. The aim of the present study was to test the ability of 12-lead electrocardiography (ECG) to discriminate between pre- and postcapillary PH in a pre-selected patient population with clinical and TTE suspicion of PH.
Methods. At a high-volume tertiary referral center for PH, admission ECGs of 251 patients were retrospectively analyzed by two cardiologists blinded to the TTE and hemodynamic parameters. We evaluated the diagnostic value of clinical parameters, N-terminal brain natriuretic peptide (NT-proBNP) and ECG findings compatible with precapillary PH. Based on parameters with the highest discriminative abilities as derived from logistic regression, we constructed decision trees and performed receiver operating characteristics (ROC) analyses.
Results. NT-proBNP (OR[95%CI] 2.01[1.21–3.33], p=0.007) and right ventricular strain (RVS) on ECG (OR[95%CI] 52.91[17.27–162.10], p<0.001) were independent predictors of precapillary PH and were automatically selected for decision tree construction. ROC analysis of the tree-based algorithm yielded incremental diagnostic information as compared to the currently used sPAP on TTE (area under the curve 0.925 vs. 0.849).
Conclusion. The incorporation of ECG and NT-proBNP into diagnostic decision making with respect to RHC may add significant independent predictive power to the current use of TTE alone.