069: Pulmonary hypertension in patients older than 70 years with preserved left ventricular function and no valvular heart disease

Abstract

Pulmonary hypertension (PH) is frequent among elderly patients. The most common causes of PH in this population are severe valve diseases and heart failure with decreased left ventricular ejection fraction (LVEF). PH in older patients without valve disease and with preserved LVEF is less known: the aim of our study was to determine the characteristics of older patients with PH despite preserved LVEF and normal valves. We included prospectively patients over 70 year of age, with PH suspected during echocardiography and confirmed by pressure measurements during right heart catheterization. The exclusion criteria were significant valve disease and LVEF under 50%. Between November 2010 and November 2011, we included 26 consecutive patients (17 women), 78±5 years old with systolic pulmonary arterial pressure of 68±15 mm Hg. Nineteen patients (73%) had been hospitalized for heart failure previously and 59% were in NYHA III-IV functional class. The six-minute walk distance was 226±132 m, the mean NT-proBNP level 1462 pg/ml. Fourteen patients (54%) had atrial fibrillation. Nine patients (35%) had a pre-capillary PH, 6 (23%) a post-capillary PH, and 11 (42%) a reactive post-capillary PH. By using transthoracic echocardiography, the right ventricular diameter was 32±5 mm and the right atrial area 29±11 cm 2 . The right ventricular systolic function was impaired, with a tricuspid annular plane systolic excursion of 17±4 mm, a peak tricuspid annular S wave of 10±6 cm/s and a peak systolic strain of the right ventricular free wall of −16±6%. Factors associated to more severe symptoms were right atrial and ventricular dilatation and higher levels of PH. Reactive post-capillary PH is predominant in elderly patients with preserved left ventricular function and no valve disease. However, more than a third of these patients have pre-capillary PH, which needs a right heart catheterization to be assessed, and could benefit from specific treatments.