INTRODUCTION: Pulmonary hypertension has many causes. While it is conventionally thought that the most prevalent is left heart disease, little information about its proportion, causes, and implications on outcome is available. METHODS: Between 1993 and 2015, 12,115 of 66,949 (18%) first adult transthoracic echocardiograms were found to have tricuspid incompetence gradient ≥40 mm Hg, a pulmonary hypertension surrogate. Left heart disease was identified in 8306 (69%) and included valve malfunction in 4115 (49%), left ventricular systolic dysfunction in 2557 (31%), and diastolic dysfunction in 1776 (21%). Patients with left heart disease, as compared with those without left heart disease, were of similar age, fewer were females (50% vs 63% P <.0001), and they had higher tricuspid incompetence gradient (median 48 mm Hg [interquartile range 43, 55] vs 46 mm Hg [42, 54] P <.0001). In reviewing trends over 20 years, the relative proportions of systolic dysfunction decreased and diastolic dysfunction increased (P for trend <.001), while valve malfunction remained the most prevalent cause of pulmonary hypertension with left heart disease. Independent predictors of mortality were age (hazard ratio [HR] 1.05; 95% CI, 1.04-1.05; P <.0001), tricuspid incompetence gradient (HR 1.02; 95% CI, 1.01-1.02, P <.0001 per mm Hg increase), and female sex (HR 0.87; 95% CI, 0.83-0.91, P <.0001). RESULTS: Overall, left heart disease was not an independent risk factor for mortality (HR 1.04; 95% CI, 0.99-1.09; P = .110), but patients with left ventricular systolic dysfunction and with combined systolic dysfunction and valve malfunction had increased mortality compared with patients with pulmonary hypertension but without left heart disease (HR 1.30; 95% CI, 1.20-1.42 and HR 1.44; 95% CI, 1.33-1.55, respectively; P <.0001 for both). CONCLUSIONS: Pulmonary hypertension was found to be associated with left heart disease in 69% of patients. Among these patients, valve malfunction and diastolic dysfunction emerged as prominent causes. Left ventricular dysfunction carries additional risk to patients with pulmonary hypertension.
INTRODUCTION:Pulmonary hypertension has many causes. While it is conventionally thought that the most prevalent is left heart disease, little information about its proportion, causes, and implications on outcome is available. METHODS: Between 1993 and 2015, 12,115 of 66,949 (18%) first adult transthoracic echocardiograms were found to have tricuspid incompetence gradient ≥40 mm Hg, a pulmonary hypertension surrogate. Left heart disease was identified in 8306 (69%) and included valve malfunction in 4115 (49%), left ventricular systolic dysfunction in 2557 (31%), and diastolic dysfunction in 1776 (21%). Patients with left heart disease, as compared with those without left heart disease, were of similar age, fewer were females (50% vs 63% P <.0001), and they had higher tricuspid incompetence gradient (median 48 mm Hg [interquartile range 43, 55] vs 46 mm Hg [42, 54] P <.0001). In reviewing trends over 20 years, the relative proportions of systolic dysfunction decreased and diastolic dysfunction increased (P for trend <.001), while valve malfunction remained the most prevalent cause of pulmonary hypertension with left heart disease. Independent predictors of mortality were age (hazard ratio [HR] 1.05; 95% CI, 1.04-1.05; P <.0001), tricuspid incompetence gradient (HR 1.02; 95% CI, 1.01-1.02, P <.0001 per mm Hg increase), and female sex (HR 0.87; 95% CI, 0.83-0.91, P <.0001). RESULTS: Overall, left heart disease was not an independent risk factor for mortality (HR 1.04; 95% CI, 0.99-1.09; P = .110), but patients with left ventricular systolic dysfunction and with combined systolic dysfunction and valve malfunction had increased mortality compared with patients with pulmonary hypertension but without left heart disease (HR 1.30; 95% CI, 1.20-1.42 and HR 1.44; 95% CI, 1.33-1.55, respectively; P <.0001 for both). CONCLUSIONS:Pulmonary hypertension was found to be associated with left heart disease in 69% of patients. Among these patients, valve malfunction and diastolic dysfunction emerged as prominent causes. Left ventricular dysfunction carries additional risk to patients with pulmonary hypertension.
Authors: Micha T Maeder; Lukas Weber; Marc Buser; Marc Gerhard; Philipp K Haager; Francesco Maisano; Hans Rickli Journal: Front Cardiovasc Med Date: 2018-05-23
Authors: Javier Bermejo; Raquel Yotti; Rocío García-Orta; Pedro L Sánchez-Fernández; Mario Castaño; Javier Segovia-Cubero; Pilar Escribano-Subías; José Alberto San Román; Xavier Borrás; Angel Alonso-Gómez; Javier Botas; María G Crespo-Leiro; Sonia Velasco; Antoni Bayés-Genís; Amador López; Roberto Muñoz-Aguilera; Eduardo de Teresa; José R González-Juanatey; Arturo Evangelista; Teresa Mombiela; Ana González-Mansilla; Jaime Elízaga; Javier Martín-Moreiras; José M González-Santos; Eduardo Moreno-Escobar; Francisco Fernández-Avilés Journal: Eur Heart J Date: 2018-04-14 Impact factor: 29.983
Authors: Javier Bermejo; Ana González-Mansilla; Teresa Mombiela; Ana I Fernández; Pablo Martínez-Legazpi; Raquel Yotti; Rocío García-Orta; Pedro L Sánchez-Fernández; Mario Castaño; Javier Segovia-Cubero; Pilar Escribano-Subias; J Alberto San Román; Xavier Borrás; Angel Alonso-Gómez; Javier Botas; María G Crespo-Leiro; Sonia Velasco; Antoni Bayés-Genís; Amador López; Roberto Muñoz-Aguilera; Manuel Jiménez-Navarro; José R González-Juanatey; Arturo Evangelista; Jaime Elízaga; Javier Martín-Moreiras; José M González-Santos; Eduardo Moreno-Escobar; Francisco Fernández-Avilés Journal: J Am Heart Assoc Date: 2021-01-05 Impact factor: 5.501
Authors: Daniel X Augustine; Lindsay D Coates-Bradshaw; James Willis; Allan Harkness; Liam Ring; Julia Grapsa; Gerry Coghlan; Nikki Kaye; David Oxborough; Shaun Robinson; Julie Sandoval; Bushra S Rana; Anjana Siva; Petros Nihoyannopoulos; Luke S Howard; Kevin Fox; Sanjeev Bhattacharyya; Vishal Sharma; Richard P Steeds; Thomas Mathew Journal: Echo Res Pract Date: 2018-09