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A2135 - Incidence Of Unrecognized Pulmonary Arterial Hypertension In Hospitalized Patients Undergoing Echocardiography
Author Block: A. L. Mora Carpio1, A. Goertz1, M. C. Rodriguez Ziccardi1, J. Serrins1, J. M. Stempel1, A. Niroula2, A. P. Quintos2, M. Rives-Sanchez2, G. S. Pressman3, S. Sharma2; 1Internal Medicine, Einstein Medical Center, Philadelphia, PA, United States, 2Pulmonary, Critical Care, Allergy and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, United States, 3Cardiovascular disease, Einstein Medical Center, Philadelphia, PA, United States.
RATIONALE: Pulmonary arterial hypertension (PAH) is an underdiagnosed and potentially fatal condition. The utility of screening all hospitalized patients undergoing echocardiography is unknown. Measurement of peak TR jet velocity and estimation of pulmonary artery systolic pressure are routinely performed, but their significance may not always be recognized by ordering physicians. We recently presented data showing that the incidence of unrecognized PAH may be as high as 11% in hospitalized patients with an echocardiogram showing a TR jet >3m/s. We hypothesized that actively screening and workup for these patients will lead to early diagnosis of PAH. OBJECTIVE: Our primary endpoint is to determine the incidence of undiagnosed PAH in inpatients undergoing echocardiography who have been identified to have a TR jet >3m/s and in whom other causes of pulmonary hypertension have been ruled out. METHODS: We designed an observational prospective cohort study in an academic community hospital in Philadelphia, PA. All hospitalized patients undergoing echocardiography for any reason where identified, those with a TR jet >3m/s were screened for possible causes of pulmonary hypertension by studying their electronic medical records. Those patients with no identifiable cause were classified as presumptive group 1 and the treating physician was informed. These patients were followed up by periodic revisions of the electronic medical record for further workup for PAH, including a right heart catheterization (RHC). Baseline demographics, medications, co-morbid conditions and RHC numbers were recorded in all patients. RESULTS: We reviewed 4512 consecutive echocardiograms and identified 454 with a TR jet >3m/s. 50 of these were classified as presumptive WHO group 1 (PAH), representing 11% of echocardiograms with a TR jet >3m/s. 8 of the 50 patients underwent further workup for pulmonary hypertension that included a RHC. Mean pulmonary artery pressure in RHC was 42.2 and mean pulmonary vascular resistance was 6.9 wood units. 5 of the 8 patients who underwent right heart catheterization where diagnosed with PAH. This represents a 62.5% incidence of PAH in this subgroup of patients. CONCLUSION: Our preliminary results suggest significant potential of early diagnosis of PAH with active screening for pulmonary hypertension in hospitalized patients undergoing echocardiography for any reason. The next step in our study will be to enroll all patients identified as possible WHO group 1 by echocardiogram in our pulmonary hypertension clinic to ensure complete follow up, workup and possible treatment to identify if early diagnosis and screening leads to improved survival and less morbidity.