CDC reports state that during 1980–2002, death rates and hospitalization rates for Pulmonary Hypertension (PH) as a contributing cause of death or any-listed hospital diagnosis increased. The present study sought to characterize the demographics, co morbidities and mortality in patients with severe pulmonary hypertension identified on Echocardiography (ECHO) in an inner city hospital.
Retrospective review of medical records of the patients reported to have severe PH on ECHOs performed during 2006. Only those patients with elevated right ventricular systolic pressure (RVSP echo) and without evidence of pulmonary outflow obstruction were included. Incomplete, unsatisfactory and duplicate studies were excluded.
Of the 3300 ECHOs, 152 patients met the criteria and had RVSP echo exceeding 60. As seen in table, mean RVSP was 71. Average age was 66 years with 58 % females, 55 % African American and 43 % Hispanics. Mortality at 6 months was 27% and 3 years was 51%. Predominant co morbidities were obstructive airway disease (OAD) and heart failure (CHF). Using logistic regression, age (p-value 0.003) and end stage renal disease (ESRD) (p-value 0.002) were independent predictors of mortality at 3 years. OAD and CHF were also associated with higher mortality (p-value 0.055).
Increased RVSP echo which is indicative of PH was seen in approximately 4.6% of the ECHOs done in this group of inner city patients. Co morbidities included OAD, CHF, Cirrhosis, ESRD, HIV, pulmonary embolism, and Obstructive sleep apnea. Age and ESRD appear to predict significantly higher risk of death in patients with severe PH.
Mortality in patients with severely elevated RVSP echo is high. Prevalence of PH in ESRD has been previously reported to be 40%. Our study shows mortality of 76% in patients with ESRD who have severe PH as compared to reported mortality in patients with ESRD in general (15–20%). Early detection by ECHO and aggressive management of PH in those patients confirmed to have PH by right heart catheterization may prevent right heart failure and early death in these patients.
Swapna Muppuri, No Financial Disclosure Information; No Product/Research Disclosure Information