To investigate the predictive value of routine electrocardiogram (ECG) in pulmonary hypertension associated with pulmonary vascular stenosis and to construct an early nomogram prediction model.Two hundred and thirty-one patients with confirmed pulmonary hypertension admitted to our hospital from January 2018 to October 2021 were selected. The patients were divided into a pulmonary vascular stenosis group and a non-stenosis group according to whether there was pulmonary vascular stenosis. General clinical data, echocardiographic data, hemodynamic data, and routine electrocardiogram characteristics of the two groups were compared. Logistic univariate and multivariate regression analyses were used to screen independent predictive factors of pulmonary vascular stenosis. A nomogram prediction model was constructed based on the independent predictive factors of pulmonary vascular stenosis. Bootstrap method was used for internal verification.There were 129 patients with pulmonary vascular stenosis in the 231 patients with pulmonary hypertension. The average age of the patients was 620 (545，680) years old and 47 patients were males (364%) and 82 were females (636%). Logistic multivariate regression analysis revealed that age (OR=1136, 95%CI: 1073~1202), pleural effusion (OR=12075, 95%CI: 2254~64678) and V1 lead S-wave amplitude (OR=1172, 95%CI: 1009~1362) were independent predictive factors for pulmonary vascular stenosis (P<005). Based on these independent predictive factors, a nomogram model was constructed. The area under the receiver operating characteristic curve (ROC) of the nomogram model was 0853. The calibration curve was close to the ideal diagonal.The nomogram model established based on age, pleural effusion, and V1 lead S-wave amplitude provides a certain reference value for predicting whether patients with pulmonary hypertension have pulmonary vascular stenosis. It helps clinicians perform early screening for pulmonary vascular stenosis.