Abstract
The value of non-invasive procedures for predicting pulmonary arterial pressure was investigated in 370 patients with chronic obstructive lung diseases and in 73 with fibrosing alveolitis in a combined study at nine centres in six European countries. Measurements included forced expiratory volume in one second, arterial blood gas tensions, standard electrocardiogram, radiographic dimensions of pulmonary artery, right ventricle dimensions by M mode echocardiography, and myocardial scintigraphy with thallium-201; and certain clinical signs were also used. No single variable was correlated closely enough to allow accurate prediction of pulmonary arterial pressure. Four methods were used to incorporate several variables into mathematical functions for predicting pulmonary arterial pressure. In patients with chronic obstructive lung disease multiple stepwise regression explained 49% of the variance in pulmonary arterial pressure but was not useful for prediction. Discriminant analysis allowed patients to be allocated to bands of pulmonary arterial pressure, as did two non-parametric procedures, in which decision trees were established using either the Kolmogoroff-Smirnoff statistic or Fisher's exact test. Patients with a pulmonary arterial pressure of 30 mm Hg or more were identified with a sensitivity of 83% and a specificity of 91%. The non-parametric tests gave better results than discriminant function. A further 54 patients were studied to validate the functions. Of these, 90% with a pulmonary arterial pressure above 20 mm Hg were correctly identified, and 80% of those with a pulmonary arterial pressure above 29 mm Hg. Similar results were obtained in subjects with fibrosing alveolitis. These mathematical functions allow the use of combinations of non-invasive procedures to select from populations at risk of pulmonary hypertension those in whom direct measurement is required. The mathematical functions are capable of further development by incorporation of variables from newer non-invasive procedures.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bishop J. M., Cross K. W. Use of other physiological variables to predict pulmonary arterial pressure in patients with chronic respiratory disease. Multicentre study. Eur Heart J. 1981 Dec;2(6):509–517. doi: 10.1093/oxfordjournals.eurheartj.a061243. [DOI] [PubMed] [Google Scholar]
- Bottoni R., Mandelli V., Marzegalli M., Moccetti T., Morpurgo M. Predditività dei criteri elettrocardiografici e vettorcardiografici nell'ipertensione arteriosa polmonare da broncopneumopatie croniche. G Ital Cardiol. 1979;9(4):390–399. [PubMed] [Google Scholar]
- ENSON Y., GIUNTINI C., LEWIS M. L., MORRIS T. Q., FERRER M. I., HARVEY R. M. THE INFLUENCE OF HYDROGEN ION CONCENTRATION AND HYPOXIA ON THE PULMONARY CIRCULATION. J Clin Invest. 1964 Jun;43:1146–1162. doi: 10.1172/JCI104999. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hicken P., Green I. D., Bishop J. M. Relationship between transpulmonary artery distance and pulmonary arterial pressure in patients with chronic bronchitis. Thorax. 1968 Jul;23(4):446–450. doi: 10.1136/thx.23.4.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Keller C. A., Shepard J. W., Jr, Chun D. S., Vasquez P., Dolan G. F. Pulmonary hypertension in chronic obstructive pulmonary disease. Multivariate analysis. Chest. 1986 Aug;90(2):185–192. doi: 10.1378/chest.90.2.185. [DOI] [PubMed] [Google Scholar]
- Marshall R. J. Partitioning methods for classification and decision making in medicine. Stat Med. 1986 Sep-Oct;5(5):517–526. doi: 10.1002/sim.4780050516. [DOI] [PubMed] [Google Scholar]
- Oswald-Mammosser M., Oswald T., Nyankiye E., Dickele M. C., Grange D., Weitzenblum E. Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy. Eur J Respir Dis. 1987 Nov;71(5):419–429. [PubMed] [Google Scholar]
- Rizzato G. F., Rampulla C., Mandelli V., Benza G. C., Mantero O., Morpurgo M. Can pulmonary artery pressure be predicted without right heart catheterization in chronic obstructive lung disease? Acta Cardiol. 1975;30(4):251–265. [PubMed] [Google Scholar]
- Simon H., Fink H., Fricke G., Ferlinz R., Kikis D. Einfluss der Blutgaspartialdrucke und der Lungenfunktsionsparameter auf den Pulmonalarterienmitteldruck beim obstruktiven Syndrome. Eine biometrische Analyse. Klin Wochenschr. 1973 Jun 1;51(11):562–564. doi: 10.1007/BF01482470. [DOI] [PubMed] [Google Scholar]
- Weitzenblum E., Moyses B., Dickele M. C., Methlin G. Detection of right ventricular pressure overloading by thallium-201 myocardial scintigraphy. Results in 57 patients with chronic respiratory diseases. Chest. 1984 Feb;85(2):164–169. doi: 10.1378/chest.85.2.164. [DOI] [PubMed] [Google Scholar]
- Weitzenblum E., Moyses B., Methlin G. Relationship between pulmonary artery mean pressure and the vertical gradient of perfusion in chronic respiratory diseases. Respiration. 1984;46(4):337–341. doi: 10.1159/000194710. [DOI] [PubMed] [Google Scholar]
- Widimský J., Tartulier M., Zielinski J., Frídl P. Prediction of pulmonary hypertension from postural changes of pulmonary transfer factor. Respiration. 1984;46(3):241–245. doi: 10.1159/000194695. [DOI] [PubMed] [Google Scholar]