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Characteristics and Outpatient Evaluation of Patients With Findings of Pulmonary Hypertension on Echocardiography FREE TO VIEW

Puneet Agarwal, MD; Sean McGarvey, MD; Aparna Balasubramanian, MD; James Katsis, MD; Isla McClelland, MD; Martin Mathias, RCIS; Monvadi Srichai, MD; Tunay Kuru, MD
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Medstar Georgetown University Hospital, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):949A. doi:10.1378/chest.2214900
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SESSION TITLE: Pulmonary Arterial Hypertension Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To describe the characteristics of patients found to have Pulmonary Hypertension (PHTN) on echocardiography (ECHO) and to determine their outpatient evaluation for PHTN.

METHODS: All ECHOs performed at Medstar-Georgetown University hospital (MGUH) over a 2-year period were retrospectively reviewed to identify patients with evidence of possible PHTN: right ventricular systolic pressure (RVSP) ≥ 50, moderate to severe (mod-sev) RV dilation or dysfunction, or intra-septal bowing. The data was then narrowed to patients who received care at MGUH outpatient clinics. Baseline demographics, comorbidities and diagnostic tests, ie PFTs, chest CT, V/Q scan, right or left heart catheterization (RHC, LHC) were extracted from electronic medical records (EMR).

RESULTS: From 5093 ECHOs, 143 patients with significant PHTN and MGUH outpatient follow up were identified. Median age was 65.6 years and 59% were male. The following possible etiologies were identified: 90 patients with cardiac disease (24 with LVEF <40%, 41 with LVEF 41-55%, 22 with mod-sev mitral or aortic valvular disease or prior repair, 3 with grade 2 or higher diastolic dysfunction); 14 with pulmonary disease (7 with prior diagnosis of COPD, 2 with mod-sev obstructive defect on PFT, 3 with mod-sev OSA on PSG, 2 with ILD on chest CT); 7 with pulmonary embolism on CT or V/Q scan; 17 with multifactorial mechanisms or other possible etiologies; and 7 with possible pulmonary arterial hypertension (PAH). Thus, 8 patients (5.6%) had no specific etiology determined for the significant PHTN found on ECHO. None had PHTN recognized as a diagnosis on the EMR, yet 6 were followed by outpatient cardiology and 1 by pulmonology. Extensive EMR reviews of these 8 patients revealed that a PHTN discussion was not documented, and a reason for not pursuing further evaluation of PTHN (e.g. patient preference, advanced age or disease) was not noted.

CONCLUSIONS: 5.6 % of patients with established outpatient care at a tertiary center were found to have significant PHTN by ECHO but did not have a complete diagnostic evaluation to determine the specific etiology of PHTN.

CLINICAL IMPLICATIONS: Despite established outpatient care, a significant minority of patients, with the finding of significant PHTN on ECHO were either unrecognized or deemed not to warrant further evaluation by outpatient physicians. This study suggests that PHTN findings on ECHO may be under-recognized and/or that physicians do not think it is worthwhile to pursue a complete PHTN evaluation and thus treatment.

DISCLOSURE: The following authors have nothing to disclose: Puneet Agarwal, Sean McGarvey, Aparna Balasubramanian, James Katsis, Isla McClelland, Martin Mathias, Monvadi Srichai, Tunay Kuru

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