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

Abstract 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). All were PH treatment naives. Hemodynamic criteria included a mean pulmonary artery pressure > 25 mmHg at rest, and a mean pulmonary wedge pressure  16 mm in diameter, pruning of peripheral pulmonary vessels. Results Eighty-two patients had PH confirmed at RHC. Weighted sensitivity of CXR was 96.9% (95% confidence interval, 94.9 to 98.2%), and weighted specificity 99.8% (95% confidence interval, 99.6 to 99.9%). By considering the 165 patients who underwent RHC, weighted sensitivity of CXR was unchanged, and weighted specificity decreased to 99.1%. None of the patients with PH were misclassified as having LHF, and vice versa. Conclusions CXR is accurate in predicting PH. It may aid clinicians in selecting patients with suspected PH for hemodynamic ascertainment.