It is important to distinguish pulmonary hypertension due to pulmonary vascular disease (with elevated pulmonary vascular resistance) from pulmonary hypertension related to elevated left-sided filling pressure. The authors are from the University of Pennsylvania, Boston Children's Hospital, Brigham and Women's Hospital and Jewish General Hospital in Montreal.
Features of pulmonary hypertension due to pulmonary vascular disease:
(1) pulmonary artery wedge pressure <= 15 mm Hg
(2) pulmonary vascular resistance > 3 WU
Patient selection: pulmonary hypertension
Parameters:
(1) ratio E to e'
(2) left atrial AP dimension in cm
(3) right ventricular outflow track pulse wave (RVOT PW) Doppler mid-systolic notch
(4) RVOT acceleration time in milliseconds
|
Parameter
|
Finding
|
Points
|
|
ratio E to e'
|
<= 10
|
0
|
|
|
> 10
|
-1
|
|
left atrial AP dimension
|
> 4.2 cm
|
-1
|
|
|
3.2 to 4.2
|
0
|
|
|
< 4.2 cm
|
1
|
|
RVOT PW Doppler mid-systolic notch
|
absent
|
0
|
|
|
present
|
1
|
|
RVOT acceleration time
|
<= 80 milliseconds
|
0
|
|
|
> 80 milliseconds
|
1
|
total score =
= (points for ratio E to e') + (points for left atrial AP dimension) + MAX(points for RVOT PW Doppler midsystolic notch, points for acceleration time)
Interpretation:
• minimum score: -2
• maximum score: +2
• A score >= 0 was 100% sensitive and 60% specific (positive predictive value 69%, negative predictive value 100%) for pulmonary hypertension due to pulmonary vascular disease.
• A patient with a score < 0 and acceleration time > 100 msec (would have to be a score of -1) will normal pulmonary vascular resistance.
Performance:
• The area under the ROC curve was 0.92.
