Background:
Pulmonary hypertension (PH) is a common severe complication of left heart disease (LHD). Group II PH includes patients with left ventricular (LV) systolic or diastolic dysfunction or valve abnormalities. We sought to investigate trends in prevalence of group II PH and its causes among patients with echocardiographically determined PH.
Methods:
All transthoracic adult echocardiograms performed from 1991 to 2014 at our center were analyzed. PH was defined as tricuspid incompetence gradient (TIG) ≥50mmHg. Echocardiographic findings suggestive of left heart disease included: (1) LV systolic dysfunction (≥moderate); (2) significant mitral or aortic dysfunction; (3) combined group 1 and 2; (4) diastolic dysfunction defined as impaired relaxation (during the first decade);
or grade III-IV (later) or left atrial enlargement (≥4.5cm) with thickened interventricular septum (≥1.4cm).
Results:
Among echocardiograms of 63,143 patients, 5719 (9%) had TIG≥50mmHg. Mean age was 75±13 years and 55% were females. Median TIG was 56 mmHg (IQR 52, 63).
The proportion of patients with significant LHD and secondary PH decreased from 78.8% to 62.1% in the last quartile, p <0.0001, p for trend 0.0001 (figure 1A).
The proportion of diastolic dysfunction remained 15% and valve dysfunction mildly increased (34-37%). The proportion of LV systolic dysfunction decreased from 11.4% to 3.6% and the combination with valve disease decreased from 17.2% to 5.8% (p<0.0001) (figure IB).
Conclusion:
Left heart disease with secondary PH is common in patients referred for transthoracic echocardiography (9%). Over the span of 20 years, the proportion of patients with group II PH decreased along with decreased proportions of LV systolic dysfunction, with no change in diastolic dysfunction or valve disease. These trends may reflect the improved treatment strategies for systolic dysfunction and call for improving treatment for diastolic dysfunction and valve disease causing PH.
