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Capillary pCO2 helps distinguishing idiopathic pulmonary arterial hypertension from pulmonary hypertension due to heart failure with preserved ejection fraction.

Olsson KM, Sommer L, Fuge J, Welte T, Hoeper MM - Respir. Res. (2015)

Bottom Line: PcCO2 values were considered helpful if they were associated with a negative predictive value >0.9 to excluded either IPAH or PH-HFpEF.According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.87 (p < 0.001).PcCO2 levels were significantly lower in IPAH compared to PH-HFpEF and may provide useful information in differentiating between both conditions.

View Article: PubMed Central - PubMed

ABSTRACT

Rationale: The demographics of patients with idiopathic pulmonary arterial hypertension (IPAH) are changing and this diagnosis is increasingly being made in older patients. However, diagnostic misclassifications are common as it may be difficult to differentiate between IPAH and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). We investigated the hypothesis that the capillary pCO2 (pcCO2) may help distinguishing between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).

Methods: In a cross-sectional study, we retrospectively assessed pcCO2 levels (obtained from arterialized capillary blood at the time of diagnosis) from patients with IPAH or PH-HFpEF, respectively. Receiver operated characteristics (ROC) were used to determine the pcCO2 level providing the best discrimination between these two conditions. PcCO2 values were considered helpful if they were associated with a negative predictive value >0.9 to excluded either IPAH or PH-HFpEF.

Results: The study enrolled 185 patients, 99 with IPAH (74% female; age 47 ± 17 years; body mass index 26 ± 5 kg/m2, PAPm 53 ± 12 mmHg, PAWP 8 ± 3 mmHg), and 86 with PH-HFpEF (64% female; age 69 ± 10 years; body mass index 30 ± 6 kg/m2, PAPm 47 ± 10 mmHg, PAWP 21 ± 5 mmHg). PcCO2 at time of diagnosis was 33 ± 4 mmHg in the IPAH group and 40 ± 5 mmHg in the PH-HFpEF group (p < 0.001), respectively. According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.87 (p < 0.001). The likelihood of PH-HFpEF was <10% in patients with a PcCO2 < 34 mmHg, whereas the likelihood of IPAH was <10% in patients with a PcCO2 > 41 mmHg.

Conclusions: PcCO2 levels were significantly lower in IPAH compared to PH-HFpEF and may provide useful information in differentiating between both conditions.

No MeSH data available.


Related in: MedlinePlus

Receiver operated characteristics (ROC) curve showing the diagnostic performance of pcCO2in distinguishing idiopathic pulmonary arterial hypertension (IPAH) from pulmonary hypertension in patients with heart failure and preserved ejection fraction (PH-HFpEF).
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Fig2: Receiver operated characteristics (ROC) curve showing the diagnostic performance of pcCO2in distinguishing idiopathic pulmonary arterial hypertension (IPAH) from pulmonary hypertension in patients with heart failure and preserved ejection fraction (PH-HFpEF).

Mentions: PcCO2 at time of diagnosis was 33 ± 4 mmHg in the IPAH group and 40 ± 5 mmHg in the PH-HFpEF group (p < 0.001), respectively (Figure 1). According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.868 (95% confidence interval, 0.816 – 0.920; p < 0.001; Figure 2). The lower pcCO2, the higher was the likelihood of IPAH and vice versa (Figure 3). PcCO2 values between 34 and 41 mmHg had limited discriminatory power, but PcCO2 values outside these margins provide valuable information. Assuming equal pre-test probability for each diagnosis, any PcCO2 < 34 mmHg excluded the presence of PH-HFpEF with a likelihood of >90%, whereas the likelihood of IPAH was <10% in patients with any PcCO2 > 41 mmHg (Figure 3). PcCO2 values >41 mmHg were found in 14% and PcCO2 levels <34 mmHg in 35% of the patients in this study, respectively; thus PcCO2 measurements provided relevant diagnostic information in 49% of the patients in this series.Figure 1


Capillary pCO2 helps distinguishing idiopathic pulmonary arterial hypertension from pulmonary hypertension due to heart failure with preserved ejection fraction.

Olsson KM, Sommer L, Fuge J, Welte T, Hoeper MM - Respir. Res. (2015)

Receiver operated characteristics (ROC) curve showing the diagnostic performance of pcCO2in distinguishing idiopathic pulmonary arterial hypertension (IPAH) from pulmonary hypertension in patients with heart failure and preserved ejection fraction (PH-HFpEF).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358848&req=5

Fig2: Receiver operated characteristics (ROC) curve showing the diagnostic performance of pcCO2in distinguishing idiopathic pulmonary arterial hypertension (IPAH) from pulmonary hypertension in patients with heart failure and preserved ejection fraction (PH-HFpEF).
Mentions: PcCO2 at time of diagnosis was 33 ± 4 mmHg in the IPAH group and 40 ± 5 mmHg in the PH-HFpEF group (p < 0.001), respectively (Figure 1). According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.868 (95% confidence interval, 0.816 – 0.920; p < 0.001; Figure 2). The lower pcCO2, the higher was the likelihood of IPAH and vice versa (Figure 3). PcCO2 values between 34 and 41 mmHg had limited discriminatory power, but PcCO2 values outside these margins provide valuable information. Assuming equal pre-test probability for each diagnosis, any PcCO2 < 34 mmHg excluded the presence of PH-HFpEF with a likelihood of >90%, whereas the likelihood of IPAH was <10% in patients with any PcCO2 > 41 mmHg (Figure 3). PcCO2 values >41 mmHg were found in 14% and PcCO2 levels <34 mmHg in 35% of the patients in this study, respectively; thus PcCO2 measurements provided relevant diagnostic information in 49% of the patients in this series.Figure 1

Bottom Line: PcCO2 values were considered helpful if they were associated with a negative predictive value >0.9 to excluded either IPAH or PH-HFpEF.According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.87 (p < 0.001).PcCO2 levels were significantly lower in IPAH compared to PH-HFpEF and may provide useful information in differentiating between both conditions.

View Article: PubMed Central - PubMed

ABSTRACT

Rationale: The demographics of patients with idiopathic pulmonary arterial hypertension (IPAH) are changing and this diagnosis is increasingly being made in older patients. However, diagnostic misclassifications are common as it may be difficult to differentiate between IPAH and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). We investigated the hypothesis that the capillary pCO2 (pcCO2) may help distinguishing between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).

Methods: In a cross-sectional study, we retrospectively assessed pcCO2 levels (obtained from arterialized capillary blood at the time of diagnosis) from patients with IPAH or PH-HFpEF, respectively. Receiver operated characteristics (ROC) were used to determine the pcCO2 level providing the best discrimination between these two conditions. PcCO2 values were considered helpful if they were associated with a negative predictive value >0.9 to excluded either IPAH or PH-HFpEF.

Results: The study enrolled 185 patients, 99 with IPAH (74% female; age 47 ± 17 years; body mass index 26 ± 5 kg/m2, PAPm 53 ± 12 mmHg, PAWP 8 ± 3 mmHg), and 86 with PH-HFpEF (64% female; age 69 ± 10 years; body mass index 30 ± 6 kg/m2, PAPm 47 ± 10 mmHg, PAWP 21 ± 5 mmHg). PcCO2 at time of diagnosis was 33 ± 4 mmHg in the IPAH group and 40 ± 5 mmHg in the PH-HFpEF group (p < 0.001), respectively. According to ROC analysis, a pcCO2 of 36 mmHg was the best discriminator between both entities with an area under curve of 0.87 (p < 0.001). The likelihood of PH-HFpEF was <10% in patients with a PcCO2 < 34 mmHg, whereas the likelihood of IPAH was <10% in patients with a PcCO2 > 41 mmHg.

Conclusions: PcCO2 levels were significantly lower in IPAH compared to PH-HFpEF and may provide useful information in differentiating between both conditions.

No MeSH data available.


Related in: MedlinePlus