In a US veteran population with echocardiographic evidence of moderate-to-severe pulmonary hypertension, only 17.3% had a documented diagnosis, and mortality was 44.1% over a mean of 832 days.
Observational (n=340)
Yes
Moderate to severe pulmonary hypertension is significantly underdiagnosed in the US Veteran population and is associated with high mortality.
BACKGROUND: Pulmonary hypertension (PH) is a key contributor to cardiovascular morbidity and early mortality; however, reports are lacking on the epidemiology of PH in at-risk patient populations. METHODS AND RESULTS: The echocardiography registries from 2 major Veterans Affairs hospitals were accessed to identify patients with at least moderate PH, defined here as a pulmonary artery systolic pressure ≥60 mm Hg detected echocardiographically. From a total of 10 471 individual patient transthoracic echocardiograms, we identified moderate or severe PH in 340 patients (332 men; mean, 77 years; mean pulmonary artery systolic pressure, 69.4±10.5 mm Hg), of which PH was listed as a diagnosis in the medical record for only 59 (17.3%). At a mean of 832 days (0-4817 days) following echocardiography diagnosing PH, 150 (44.1%) patients were deceased. PH was present without substantial left heart remodeling: the mean left ventricular ejection fraction was 0.50±0.16, left ventricular end-diastolic dimension was 5.0±0.9 cm, and left atrial dimension was 4.4±0.7 cm. Cardiac catheterization (n=122, 36%) demonstrated a mean pulmonary artery pressure of 40.5±11.4 mm Hg, pulmonary capillary wedge pressure of 22.6±8.9 mm Hg, and pulmonary vascular resistance of 4.6±2.9 Wood units. Diagnostic strategies for PH were variable and often incomplete; for example, only 16% of appropriate patients were assessed with a nuclear ventilation/perfusion scan for thromboembolic causes of PH. CONCLUSIONS: in an at-risk patient population, PH is underdiagnosed and associated with substantial mortality. Enhanced awareness is necessary among practitioners regarding contemporary PH diagnostic strategies.
Maron et al. (Sáb,) realizaram um estudo observacional em Hipertensão pulmonar (n=340). Em uma população de veteranos dos EUA com evidência ecocardiográfica de hipertensão pulmonar moderada a grave, apenas 17,3% tinham um diagnóstico documentado, e a mortalidade foi de 44,1% ao longo de uma média de 832 dias.
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