PT  - JOURNAL ARTICLE
AU  - Maria Kokosi
AU  - Greg Keir
AU  - John Wort
AU  - Peter George
AU  - Arjun Nair
AU  - David Hansell
AU  - Simon Walsh
AU  - Joseph Jacob
AU  - Athol Wells
TI  - Pulmonary hypertension in interstitial lung disease: Non-invasive assessment for detection and prognosis
AID  - 10.1183/13993003.congress-2016.PA801
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA801
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA801.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA801.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Background: Pulmonary hypertension (PH) in interstitial lung disease (ILD) is often associated with significant morbidity and mortality. Right heart catheterization (RHC) remains the gold standard diagnostic investigation for PH, although co-existing ILD can confound interpretation of non-invasive PH screening tests. We evaluated the utility of individual and combined non-invasive investigations in diagnosing ILD-PH.Methods: A retrospective analysis of consecutive patients with ILD and suspected PH who completed comprehensive functional and haemodynamic assessment, including RHC. Non-invasive screening tests evaluated included echocardiogram, main pulmonary artery diameter (mPA) on CT scan, serum BNP, pulmonary function test profile, and 6 minute walk test. Linear and multivariate regression analysis was conducted to identify if a composite index of variables could be derived to predict mPAP. A predictive equation was derived in group A (n=114), and tested in a separate cohort (group B; n=95).Results: In two hundred and nine patients (mean age 62.1 ± 10.7 years; 96 males), PH was confirmed in 166 (79.4%; mPAP 38.4±9.8 mmHg). In group A, a model was constructed to fit non-invasive variables to mPAP: mPAP=(RVSP x 0.19)+(0.69 x mPA diameter)+(0.03 x BNP). Testing the equation in Group B demonstrated a sensitivity of 98.8% (95% CI: 93.5-100%), specificity 55.6% (CI: 21.2-86.3%), positive predictive value 95.4% (CI: 88.5-98.7%) and negative predictive value 83.3% (CI: 35.9-99.6%).Conclusion: A composite index incorporating echocardiographic, CT and BNP variables was more strongly related to mPAP than any individual measurement in isolation.