Accuracy of chest radiography in predicting pulmonary hypertension: A case-control study

Objective: To assess the accuracy of chest radiography (CXR) in predicting pulmonary hypertension (PH). Methods: We studied 108 consecutive patients with suspected PH who underwent right heart catheterization (RHC). To avoid a selection bias which could be introduced by examining only patients with suspected PH, we included in the analysis the CXR of 454 additional patients with different diagnosis: 57 with left heart failure (LHF) and pulmonary venous hypertension at RHC, 197 with chronic obstructive pulmonary disease, and 200 non-obstructed controls. CXR were examined independently by 4 raters, who were blinded to clinical, hemodynamic, and spirometric data. The diagnosis of PH was made if a prominent main pulmonary artery was associated with anyone of: isolated enlargement of right ventricle, right descending pulmonary artery N 16 mm in diameter, pruning of peripheral pulmonary vessels. Conclusions: CXR is accurate in predicting PH. It may aid clinicians in selecting patients with suspected PH for hemodynamic ascertainment.