Girgis and Mathai listed clinical findings that may indicate the presence of pulmonary hypertension (PH) in a patient with a chronic respiratory disease.
Patient selection: chronic respiratory disease, such as COPD
Parameters:
(1) Medical Research Council (MRC) dyspnea grade
(2) signs of right heart failure
(3) appearance of central pulmonary arteries on a chest X-ray
(4) ECG evidence of right heart strain
(5) diffusion capacity of carbon monoxide (DL-CO) as a percent of predicted
(6) 6 minute walk distance in meters
(7) oxygen desaturation with exercise
(8) serum BNP or pro-BNP levels
|
Parameter |
Finding |
Points |
|
MRC dyspnea grade |
1 or 2 |
0 |
|
|
3, 4 or 5 |
1 |
|
signs of right heart failure |
absent |
0 |
|
|
present |
1 |
|
central pulmonary arteries on chest X-ray |
normal |
0 |
|
|
enlarged |
1 |
|
right heart strain on ECG |
absent |
0 |
|
|
present |
1 |
|
DL-CO as percent of predicted |
>= 50% |
0 |
|
|
< 50% |
1 |
|
6 minute walking distance |
>= 300 meters |
0 |
|
|
< 300 meters |
1 |
|
oxygen desaturation during exercise |
absent |
0 |
|
|
present |
1 |
|
serum BNP or pro-BNP |
< 2 times the upper limit of normal (ULN) |
0 |
|
|
>= 2 times ULN |
1 |
number of indicators present =
= SUM(points for all 8 parameters)
Interpretation:
• minimum number of indicators: 0
• maximum number of indicators: 8
• The presence of >= 2 indicators suggests the presence of pulmonary hypertension and justifies screening echocardiography.
Specialty: Pulmonology, Cardiology
