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Pulmonary hypertension (PH) is a key contributor to decreased quality of life and early mortality. The U.S. Veteran patient population is associated with elevated rates of cardiopulmonary diseases that promote PH. However, there are no reports on the prevalence, clinical profile, or diagnostic accuracy of PH in Veteran patients.
The Veterans Affair Boston Healthcare System echocardiography registry was used to determine the number of patients with PH detected by echocardiography from 2008 to 2011. PH was defined as a pulmonary artery systolic pressure (PASP) >35 mmHg. Medical records were analyzed for clinical, diagnostic, and outcome data of patients with severe PH (PASP > 60 mm Hg).
From a total of 8584 patients, we identified PH in 1179 (13.7%) patients, of whom 81 (79 men; mean 74 y, 67-96 y,) had severe PH (mean PASP 70.5 ± 9.3 mm Hg, range 60-102 mm Hg). At a median of 242 days (1-660 d) following echocardiography diagnosing severe PH, 27 (33%) patients were deceased. The mean number of comorbidities per patient listed in the medical chart was 14.9, with cardiovascular and pulmonary diseases accounting for 4.4 and 1.1 comorbidities per patient, respectively. Despite this, PH was reported as a diagnosis for only 12 (14.8%) patients. Severe PH was present without evidence of substantial left heart remodeling: the mean left ventricular (LV) ejection fraction was 50 ± 17%, LV septal thickness 1.1 ± 0.29 cm, LV end-diastolic dimension was 4.9 ± 1.0 cm, and left atrial dimension was 4.4 ± 0.9 cm. Severe PH patients undergoing right heart catheterization (RHC) (n=39) demonstrated a mean PA pressure of 40.4 ± 11.4 mm Hg and pulmonary capillary wedge pressure (PCWP) of 22.1 ± 8.7 mm Hg. Despite elevations in PCWP, pulmonary vascular resistance was 4.9 ± 3.9 Wood units. A complete PH diagnostic evaluation including a RHC, echocardiogram, pulmonary function test, and chest computer tomography occurred in only 8 (9.9%) severe PH patients.
In Veteran patients, severe PH, which is amenable to treatment, is under recognized and associated with substantial mortality. Enhanced awareness is necessary among clinical cardiologists regarding contemporary PH diagnostic strategies.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pulmonary Hypertension: Epidemiology, Prognosis, Outcomes
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 1251M-155
- 2013 American College of Cardiology Foundation