PURPOSE: Since Pulmonary Arterial Hypertension (PAH) presents usually at a very late stage, early diagnosis is a key to proper management and better outcome. The aim of the study is to compare two commonly done routine tests, chest roentgenography (CXR) and Electrocardiogram (EKG), as predictors of the diagnosis of PAH which is eventually confirmed by Echocardiography (Echo).
METHODS: All the Echo studies done for the year 2005 in our institution were retrospectively reviewed and 190 cases documented to have PAH (having pulmonary artrey systolic pressure ≥35 mmHg)were selected for the study. EKGs and CXRs were reviewed in all 190 cases. Data collected include EKG findings consistent with PAH (prominent p wave of amplitude ≥2.5 mV in leads II and III, R/S in lead V1 ≥1, right axis deviation (RAD)≥ 90°. Prominent pulmonary arteries (PPA) alone or PPA with Cardiomegaly (CMG) were the radiographic criteria selected as indicators of PAH. Obvious pulmonary pathologies on CXR were not included as criteria.
RESULTS: EKGs of patients with PAH documented by Echo showed features of PAH: prominent p wave in only 14 of 190 patient (7%), R/S in V1 20 of 190 (11%), RAD 23 of 190 (12%). Patients who demonstrated two combined EKG criteria were 7 of 190 (4%). No patient showed all 3 criteria. However, CXR findings of PPA were 64 of 190 (34%) and 56 of 190 (29%) in PPA with CMG.
CONCLUSION: CXR findings (34% of PPA alone and 29% for PPA with CMG ) are more prevalent in patients diagnosed with PAH(confirmed by Echo)compared with EKG findings of the same patients (4% based on 2 criteria, and an average of 10% based on a single criterion).
CLINICAL IMPLICATIONS: PPA with or without CMG should alert clinicians to conduct more investigations and specially to request an Echo to rule out or to confirm PAH which can alter the management and the prognosis, and subsequentely the outcome if diagnosed early enough.
DISCLOSURE: Nada Nasser, None.