C64-09 Echo to Right Heart Catheterization: Assessing Bottlenecks in Pre-Capillary Pulmonary Hypertension Diagnosis

Abstract Introduction The diagnosis of pulmonary hypertension is challenging. Prior well-curated PAH registries demonstrate that the median time from symptoms to diagnosis is greater than 1 year. Delays in diagnosis are associated with worse functional impairment and mortality. By capturing data from all available Echo and RHC performed within a single health system, we seek to understand echocardiographic features contributing to diagnostic delays in patients with precapillary pulmonary hypertension. Methods The Mass General Brigham Research Patient Data Registry (RPDR) was retrospectively screened to identify all patients with one echocardiogram and an initial diagnostic right heart catheterization completed within 6 months after the available echocardiogram. Utilizing a custom artificial intelligence data extraction pipeline, the unstructured right heart catheterization and echocardiogram data were systematically processed. Relevant demographic, hemodynamic, and echocardiogram data were obtained for 3537 patients with a paired RHC and echocardiogram and enriched to identify patients who met criteria for pre-capillary pulmonary hypertension by right heart catheterization. Results In patients with paired RHC/ECHOs from 2010-2023, 741/3537 (21%) patients with precapillary PH by RHC with normal to mild left atrial size were identified. The average TRV on echocardiogram was 3.13 m/s. A statistically significant correlation between TRV and mPAP (R: 0.639) was observed. Patients with TRV 3.4 had longer time to RHC than those greater or equal to 3.4 m/s (36 d v 29 d, p = 0.04). Time from echo to diagnostic catheterization of pre-capillary pulmonary hypertension was similar in patients with normal left atria size and mild left atrial size, (35 d vs 33 days, p = 0.28) There was no significant difference in time from Echo to diagnostic catheterization by age (65 vs 65, 35 d v 32 d, p = 0.29). There was a significantly longer time to diagnostic RHC in patients obtaining echocardiograms obtained after 2017 vs clinical care before 2017 (38 vs 28 d, p = 0.003). Conclusions Analysis of paired initial echo and right heart catheterization data reveals that a lower tricuspid regurgitant velocity on Echo led to longer time to diagnostic right heart catheterization in patients with precapillary pulmonary hypertension. Advanced age and mild left atrial dilation, factors associated with HFpEF and other cardiac comorbidities, were not associated with a longer diagnostic interval between studies. Future work on our large hemodynamic and Echo database aims to make well-powered observational insights to improve the diagnostic and therapeutic management of patients with pulmonary hypertension. This abstract is funded by: None