Performance summary of the pulmonary hypertension (PH) early detection algorithm (PH-EDA) in detecting PH in each of the time windows
| Mayo Clinic test sets | VUMC test sets | |||||||
|---|---|---|---|---|---|---|---|---|
| Diagnostic (1 month pre/post-diagnosis) | Pre-emptive (6–18 months pre-diagnosis) | ECGs 18–36 months pre-diagnosis | ECGs 36–60 months pre-diagnosis | Diagnostic (1 month pre-/post-diagnosis) | Pre-emptive (6–18 months pre-diagnosis) | ECGs 18–36 months pre-diagnosis | ECGs 36–60 months pre-diagnosis | |
| All patients | ||||||||
| PH patients# | 16 175 | 4985 | 4784 | 4135 | 6045 | 1880 | 1602 | 1321 |
| Control patients# | 87 998 | 87 998 | 87 998 | 87 998 | 24 256 | 24 256 | 24 256 | 24 256 |
| AUC | 0.92 (0.92–0.92) | 0.86 (0.86–0.86) | 0.82 (0.82–0.83) | 0.79 (0.78–0.79) | 0.88 (0.87–0.88) | 0.81 (0.80–0.82) | 0.78 (0.77–0.79) | 0.73 (0.72–0.75) |
| Sensitivity, % | 85.51 (85.11–85.94) | 70.84 (69.97–71.59) | 61.58 (60.72–62.46) | 53.04 (52.04–54.41) | 82.33 (81.65–83.11) | 68.51 (67.37–69.54) | 62.45 (60.66–64.02) | 56.37 (54.62–58.50) |
| Specificity, % | 83.81 (83.63–83.99) | 83.81 (83.63–83.99) | 83.81 (83.63–83.99) | 83.81 (83.63–83.99) | 76.95 (76.62–77.41) | 76.95 (76.62–77.41) | 76.95 (76.62–77.41) | 76.95 (76.62–77.41) |
| Diagnostic OR | 30.55 (29.49–31.74) | 12.58 (12.01–13.13) | 8.30 (7.99–8.58) | 5.85 (5.59–6.21) | 15.57 (14.70–16.59) | 7.27 (6.88–7.73) | 5.56 (5.14–5.93) | 4.32 (3.97–4.70) |
| PPV¶ | 0.49 (0.49–0.50) | 0.20 (0.19–0.20) | 0.17 (0.17–0.17) | 0.13 (0.13–0.14) | 0.47 (0.47–0.48) | 0.19 (0.18–0.19) | 0.15 (0.15–0.16) | 0.12 (0.11–0.12) |
| NPV¶ | 0.97 (0.97–0.97) | 0.98 (0.98–0.98) | 0.98 (0.98–0.98) | 0.97 (0.97–0.98) | 0.95 (0.94–0.95) | 0.97 (0.97–0.97) | 0.97 (0.97–0.97) | 0.97 (0.97–0.97) |
| PPV¶ (Mayo 2.87/VUMC 3.09% prev.) | 0.13 (0.13–0.14) | 0.11 (0.11–0.12) | 0.10 (0.10–0.10) | 0.09 (0.09–0.09) | 0.10 (0.10–0.10) | 0.09 (0.08–0.09) | 0.08 (0.08–0.08) | 0.07 (0.07–0.07) |
| NPV¶ (Mayo 2.87/VUMC 3.09% prev.) | 0.99 (0.99–1.00) | 0.99 (0.99–0.99) | 0.99 (0.99–0.99) | 0.98 (0.98–0.98) | 0.99 (0.99–0.99) | 0.99 (0.99–0.99) | 0.98 (0.98–0.99) | 0.98 (0.98–0.98) |
| Threshold | 0.308 | 0.308 | 0.308 | 0.308 | 0.308 | 0.308 | 0.308 | 0.308 |
| Dyspnoea subset | ||||||||
| PH patients# | 7155 | 2187 | 1811 | 1286 | 3719 | 1147 | 909 | 678 |
| Control patients# | 16 155 | 16 155 | 16 155 | 16 155 | 9208 | 9208 | 9208 | 9208 |
| AUC | 0.90 (0.90–0.90) | 0.85 (0.84–0.85) | 0.82 (0.81–0.83) | 0.79 (0.79–0.80) | 0.86 (0.85–0.87) | 0.80 (0.79–0.82) | 0.78 (0.76–0.79) | 0.73 (0.72–0.75) |
| Sensitivity, % | 82.78 (81.99–83.52) | 70.08 (68.44–71.62) | 64.46 (62.57–66.67) | 57.48 (55.25–59.40) | 78.71 (77.30–79.74) | 66.90 (65.09–68.74) | 61.72 (59.52–63.30) | 53.64 (50.82–56.11) |
| Specificity, % | 81.58 (81.15–82.01) | 81.58 (81.15–82.01) | 81.58 (81.15–82.01) | 81.58 (81.15–82.01) | 77.80 (77.07–78.41) | 77.80 (77.07–78.41) | 77.80 (77.07–78.41) | 77.80 (77.07–78.41) |
| Diagnostic OR | 21.30 (20.15–22.45) | 10.39 (9.64–11.38) | 8.05 (7.35–8.94) | 6.00 (5.44–6.44) | 12.97 (11.97–14.02) | 7.09 (6.43–7.79) | 5.66 (5.09–6.09) | 4.06 (3.60–4.51) |
| PPV¶ | 0.67 (0.66–0.67) | 0.34 (0.33–0.35) | 0.28 (0.27–0.29) | 0.20 (0.19–0.21) | 0.59 (0.58–0.60) | 0.27 (0.26–0.28) | 0.22 (0.21–0.23) | 0.15 (0.14–0.16) |
| NPV¶ | 0.91 (0.91–0.92) | 0.95 (0.95–0.96) | 0.95 (0.95–0.96) | 0.96 (0.96–0.96) | 0.90 (0.89–0.91) | 0.95 (0.95–0.95) | 0.95 (0.95–0.96) | 0.96 (0.95–0.96) |
| PPV¶ (Mayo 6.12/VUMC 6.23% prev.) | 0.23 (0.22–0.23) | 0.20 (0.19–0.20) | 0.19 (0.18–0.19) | 0.17 (0.16–0.17) | 0.19 (0.19–0.20) | 0.17 (0.16–0.17) | 0.16 (0.15–0.16) | 0.14 (0.13–0.15) |
| NPV¶ (Mayo 6.12/VUMC 6.23% prev.) | 0.99 (0.99–0.99) | 0.98 (0.98–0.98) | 0.97 (0.97–0.97) | 0.97 (0.97–0.97) | 0.98 (0.98–0.98) | 0.97 (0.97–0.97) | 0.97 (0.97–0.97) | 0.96 (0.96–0.96) |
| Threshold | 0.38 | 0.38 | 0.38 | 0.38 | 0.38 | 0.38 | 0.38 | 0.38 |
Data are presented as n, unless otherwise stated; data in parentheses are 95% confidence intervals. VUMC: Vanderbilt University Medical Center; AUC: area under the curve; PPV: positive predictive value; NPV: negative predictive value. #: numbers of patients sum to greater than the total number of patients included in this study, as patients could belong to more than one group, e.g. if they had an ECG within 1 month of right heart catheterisation (RHC) and another ECG 36 months before RHC; ¶: PPV and NPV vary according to the prevalence of PH in the given population: PH prevalence in the Mayo Clinical population, 2.87%, increased to 6.12% among patients with relevant dyspnoea International Classification of Disease (ICD) codes; PH prevalence in the VUMC population, 3.09%, increased to 6.23% among patients with relevant dyspnoea ICD codes.