Pulmonary hypertension (PH) is an underrecognized, potentially fatal cardiopulmonary disease. Many patients with echocardiographic evidence of PH never receive additional evaluation. This study seeks to identify the patient characteristics and associated relevant echocardiographic data that provoke further evaluaton of elevated pulmonary artery pressures.
We retrospectively evaluated 3,960 2-D echocardiogram reports performed at the Cincinnati VAMC from 2005 to 2006. All patients without known PH, an estimated pulmonary artery (PA) pressure of ≥ 40 mm Hg and an ejection fraction (EF) of ≥ 50% were included. The primary endpoint was referral for a pulmonary consult, a cardiology consult, right heart catheterization, or a follow up echocardiogram. Medians and rates were compared using Wilcoxon rank sum tests and Fischer's exact tests, respectively.
Two hundred twenty-nine (5.8%) patients had echocardiograms that met inclusion criteria and demonstrated elevated PA pressures. Fifty-four (23.5%) were referred for further evaluation. A significantly higher median PA pressure (50.8 mmHg vs 46 mm Hg) was observed in patients who were referred versus those who were not referred (p < 0.01). Patients in the referred group were also more likely to have increased right ventricular size (58% vs 19.4%, p < 0.01), increased right atrial dimension (84.6% vs 45.8%, p < 0.01), and decreased right ventricular function (54.8% vs 10.5%, p < 0.01) than those in the non-referred group. Age, gender, race, study indications to assess PA pressure and/or right heart function, and echocardiographic evidence of diastolic dysfunction do not correlate with referral patterns.
Only one of every four patients with echocardiographic evidence of pulmonary hypertension undergoes further evaluation. Echocardiographically measured PA pressures greater than 50 mm Hg and evidence of right heart pressure overload are associated with an increased likelihood for referral.
Echocardiographic evidence of pulmonary hypertension is frequently disregarded. Further clinical education is needed to improve the recognition and evaluation of PH.
John Kingrey, No Financial Disclosure Information; No Product/Research Disclosure Information