Noninvasive findings reduce catheterisation need in suspected PAH

By Eleanor McDermid, Senior medwireNews Reporter

Research shows that a risk score based on noninvasive measures can identify left heart failure (LHF) in a “substantial percentage” of patients with suspected pulmonary arterial hypertension (PAH), reducing the need for right heart catheterisation (RHC).

The risk score was developed using data from 300 PAH and 80 LHF patients, and comprised the sum of the electrocardiography measures SV1 (S deflection in V1) and RV6 (R deflection in V6); left valvular heart disease (LVH) that was worse than mild, and left atrial dilation on echocardiography; and a history of left heart disease.

These features were independent predictors of LHF in the study patients, with a history of left heart disease increasing the likelihood 10.0-fold, left atrial dilation increasing it 12.2-fold, left valve disease increasing it 7.5-fold and each mm increment in the sum of SV1 and RV6 increasing it 1.12-fold.

“The advantage of the approach used in our study is that it does not require sophisticated measures”, the researchers write in the European Respiratory Journal.

At a cutoff of 72 points, the derived risk score had 100% specificity and a 100% positive predictive value for LHF in a validation cohort of 79 PAH and 55 LHF patients. It allowed the noninvasive diagnosis of 20% of the LHF patients without misclassifying any PAH patients.

Therefore, using this risk model, one in five patients suspected of having PAH but actually having pulmonary hypertension secondary to LHF would be spared the need for RHC.

Researcher Anton Vonk-Noordegraaf (VU University Medical Center, Amsterdam, the Netherlands) and team note that increased awareness of pulmonary hypertension, “in combination with high LHF prevalence and, in particular, difficulties in diagnosing heart failure with preserved ejection fraction noninvasively have increased referrals to PAH centres and the number of RHCs performed.”

They say: “A model to predict, in advance, the likelihood of LHF could decrease the burden to the patient and economic cost associated with these referrals.”

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