PURPOSE: Pulmonary venous hypertension (PVH) is an increasingly recognized cause of morbidity. Patients with PVH are frequently referred to pulmonary hypertension (PH) sub-specialty clinics for management of their dyspnea. However, the clinical characteristics of PVH have not been well defined or standardized, making the study of this population difficult. We describe a large cohort of patients with PVH to better understand their clinical presentation and mortality.
METHODS: Medical records were reviewed for patients presenting to the UT Southwestern PH clinic (2003-2010). Patients with WHO Group II PH and a LVEF greater than 50%, who completed right heart catheterization were included. Clinical data including demographics, hemodynamics and baseline cardiopulmonary testing were collected. The social security database was queried for mortality.
RESULTS: 169 patients were studied; 82% were female. The mean age was 65. The patients were markedly dyspneic at presentation with 57% classified as NYHA functional class III, 37% class II, 5% class IV and 1% class I. Baseline mean 6MWT distance was 292m (median 295m). Mean systemic blood pressure was 133/70, with a median of 132/69. EKG revealed a RBBB in 7% of patients, and RVH in 11%. Right ventricular function on echocardiogram was normal in 80%, 7% mildly reduced, 9.5% moderately reduced, and 3.5% severely reduced. Right heart catheterization revealed: mean RAP 13.3mmHg (median 12mmHg), mean mPAP 37.5mmHg (median 36mmHg), mean PAOP 19mmHg (median 19mmHg), mean cardiac index 3L/min/m2 (median 2.8L/min/m2), mean PVR 3.56 wood units(wu) (median 2.95 wu). At the time of follow-up, 25/169 (15%) were deceased.
CONCLUSIONS: PVH is characterized by significant dyspnea and functional limitation as measured by 6MWT. Patients who present with PVH tend to be older, female, and mildly hypertensive. Right heart catheterization reveals a moderately elevated mPAP and a mildly elevated PVR with elevated left-sided filling pressures. Most, but not all, patients present with preserved RV function on echocardiogram.
CLINICAL IMPLICATIONS: Defining the characteristics of PVH will allow consistent collection of data across centers and the development of inclusion/exclusion criteria for clinical trials to intervene upon this debilitating disease.
DISCLOSURE: The following authors have nothing to disclose: Jeffrey Link, F. Torres, Kelly Chin, Sojna Bartolome
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