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Modality | Advantages | Disadvantages |
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ECG | Noninvasive, cheap, and readily available. High specificity for RVH. ECG may reveal other findings such LAE, LVH, or old MI that suggests an alternative cause of PH | Absence of RVH does not rule out PH. |
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CXR | Non-invasive, cheap, and readily available. An ↑ in the diameter of the right descending pulmonary artery to >16 mm on the PA projection, combined with an ↑ in the diameter of the left descending pulmonary artery of >18 mm on the left lateral projection, has a high sensitivity of 98% for PH | Normal-sized pulmonary artery does not rule out PH. |
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BNP | Requires only a blood draw, is cheap and readily available. | ↑ BNP also correlated with lower PaO2 suggesting that BNP can also be released in response to hypoxia. More studies are needed. |
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eNO | Non-invasive. | Expensive, not widely available and has been tested in only one study. |
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ECHO | High NPV of sPAP or RV abnormalities (93% and 96%, resp.) makes it an excellent screening test. Moreover, it provides additional data for example, LVEF, LV filling pressures, valvular function. | Hyperinflation may preclude optimal visualization of the heart. Although the NPV is high enough to exclude PH, the presence of a high sPAP or RV abnormalities requires confirmation by RHC. |
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Chest CT | Non-invasive, widely available. High PPV of 95%-96% for PH. LAE could suggest left heart dysfunction. | Expensive. Radiation exposure. Normal sized pulmonary artery does not rule out PH. |
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Cardiac MRI | Non-invasive, does not involve ionizing radiation, and is not affected by hyperinflation. | Expensive, not widely available and in some cases claustrophobia can be a problem. |
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RHC | “Gold standard” Confirms diagnosis. Determines severity. Distinguishes occult LV dysfunction from hyperinflation when PAWP is ↑. Measures CO and allows calculation of PVR. Determines responsiveness to O2. | Invasive. Interpretation of pressures may be difficult when there are large respiratory swings. |
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