Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension

Background and PurposeEarly, preferably noninvasive, detection of pulmonary hypertension improves prognosis. Our study evaluated the diagnostic accuracy of the electrocardiographically derived Butler–Leggett (BL) score and ventricular gradient (VG) to estimate mean pulmonary artery pressure (PAP).MethodsIn 63 patients with suspected pulmonary hypertension, BL score and VG were calculated. The VG was projected on a direction optimized for detection of right ventricular pressure overload (VG-RVPO). BL score and VG-RVPO were entered in multiple linear regression analysis and the diagnostic performance to detect PH (invasively measured mean PAP ≥ 25 mmHg) was assessed with receiver operating characteristic analysis.ResultsBoth BL score and VG-RVPO correlated significantly with mean PAP (r = 0.45 and r = 0.61, respectively; P < 0.001). Combining BL score and VG-RVPO increased the correlation to 0.67 (P < 0.001). The diagnostic performance of this combination for the detection of PH was good with an area under the curve of 0.79 (P < 0.001).ConclusionCombination of the BL score and VG-RVPO allows for accurate detection of increased PAP.