Can echocardiography discriminate between pulmonary arterial hypertension and pulmonary hypertension related to left heart disease in patients with cardiovascular risk factors?

Abstract

Purpose: As the prevalence of cardiovascular risk (CV) factors is increasing by age, the diagnosis of pulmonary arterial hypertension (PAH) is becoming more challenging. The purpose of this study was to assess whether transthoracic echo-cardiography may help to differentiate between PAH and pulmonary hypertension (PH) related to left heart disease (PH-LHD) in PH patients with CV factors before cardiac catheterization. Methods: We retrospectively studied consecutive incident PH patients at a single centre between 01 January 2008 and 15 July 2011. All patients underwent cardiac catheterization. We selected those who had at least one of the following CV factors: systemic hypertension, type 2 diabetes mellitus, permanent atrial fibrillation, coronary artery disease, obesity or mitral and/or aortic disease. We divided the patients into two groups: a PAH group (PAH-CV) and a PH-LHD group. After Bonferroni correction the statistical threshold shifted to 0.001 level. (Table presented) Results: The results are shown in Table 1. Conclusions: 1. In PHLHD left atrial and ventricular dimensions are greater than in PAH 2. In PAH the right ventricle expands at the expense of the left ventricle 3. In PAH tricuspid regurgitation peak velocity is higher and pericardial effusion is more common. These differences show the potentially helpful role of echocardiography in discrimination between PAH and PH-LHD in patients with PH and CV factors.