A noninvasive predictive model incorporating medical history, ECG, and echocardiography diagnosed left heart failure with an AUC of 0.93, potentially reducing right heart catheterisations by 20%.
Observational (n=514)
No
Can a noninvasive predictive model using medical history, ECG, and echocardiography accurately diagnose left-sided heart failure in patients suspected of pulmonary arterial hypertension?
A noninvasive risk score using medical history, ECG, and echocardiography can accurately identify left-sided heart failure in patients suspected of PAH, potentially reducing the need for invasive right heart catheterization.
Effect estimate: AUC 0.93
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.
Jacobs et al. (Thu,) conducted a observational in Suspected pulmonary arterial hypertension (n=514). Noninvasive predictive model (medical history, ECG, echocardiography) was evaluated on Diagnosis of left heart failure (AUC 0.93). A noninvasive predictive model incorporating medical history, ECG, and echocardiography diagnosed left heart failure with an AUC of 0.93, potentially reducing right heart catheterisations by 20%.
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