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High prevalence of occult left heart disease in scleroderma-pulmonary hypertension.
MedLine Citation:
PMID:  23258775     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
What is the prevalence of occult left-heart disease in patients with scleroderma (SCL) and pulmonary hypertension (PH)? In patients with PH (mean pulmonary artery pressure mPAP≥25 ;mmHg), differentiation between pre/post capillary PH has been made according to pulmonary artery wedge pressure (PAWP) less/more than15 ;mmHg, respectively.Retrospective chart review of 107 SCL-patients. All patients with suspected PH had routine right/left heart catheterization with left ventricular end-diastolic pressure (LVEDP) measurement pre/post fluid challenge. We extracted demographic, hemodynamic and echocardiographic data. Patients were classified into one of four groups - hemodynamically normal (mPAP<25 ;mmHg), pulmonary venous hypertension PVH (mPAP≥25 ;mmHg, PAWP>15 ;mmHg), occult PVH (mPAP≥25 ;mmHg, PAWP≤15 ;mmHg, LVEDP>15 ;mmHg before/after fluid challenge) and Pulmonary Arterial Hypertension PAH (mPAP≥25 ;mmHg, PAWP≤15 ;mmHg and LVEDP≤15 ;mmHg before/after fluid challenge).Fifty-three of 107 patients had PH. Based on the PAWP-based definition 29/53 had PAH and 24/53 had PVH. After considering the resting and post-fluid-challenge LVEDP, 11 PAH patients were reclassified as occult PVH. The occult PVH group was hemodynamically, echocardiographically and demographically closer to the PVH group than the PAH group.PVH had high prevalence in our SCL-PH population. Distinguishing PAH from PVH with only PAWP may result in some PVH patients being misclassified as having PAH.
Authors:
Benjamin D Fox; Avi Shimony; David Langleben; Andrew Hirsch; Lawrence Rudski; Robert Schlesinger; Mark J Eisenberg; Dominique Joyal; Marie Hudson; Kim Boutet; Alexandrina Serban; Ariel Masetto; Murray Baron
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-20
Journal Detail:
Title:  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology     Volume:  -     ISSN:  1399-3003     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Divisions of Cardiology, Respirology and Rheumatology, and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
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