084: Aetiology of 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 and frequently due to severe valve diseases or heart failure with decreased left ventricular (LV) ejection fraction. The part of other causes is less known. The aim of this prospective study is to determine the aetiology of PH in older patients with preserved LV ejection fraction and no valve disease. We included prospectively patients over 70 years of age with LV ejection fraction >50%, no valve disease. PH was suspected during echocardiography and confirmed by pressure mesurements during right heart catheterization. Each patient had complementary tests (blood tests, pulmonary function tests, ventilation perfusion lung scan, chest CT, abdominal ultrasound scan), conditioned by the haemodynamic characteristics of PH, in order to determine its cause. Between November 2010 and November 2011, we included 26 patients (17 women), 78+/-years old, with peak systolic pulmonary pressure of 68+/-15mmHg. Nine patients (35%) had a precapillary PH. Among them, PH was the consequence of thromboembolism (n=3), idiopathic (n=3), due to a connective tissue disease (n=1) and to a chronic lung disease (n=2). Six patients (23%), all with LV distolic dysfunction, had a post capillary PH. Two of them had previously undergone cardiac surgery for atrial septal defect and mitral valve remplacement. Eleven patients (42%) had a reactive post capillary PH. PH was idiopathic in 2 cases and drug induced for one patient. We found 2 connective tissue diseases, one thromboembolic disease, 2 chronic lung diseases. Four patients had a LV distolic dysfunction. One patient had two causes of PH. When LV diastolic dysfunction was the only cause of PH, it was always associated with persistent atrial fibrillation. Reactive post capillary PH is predominant in elderly patients with preserved systolic LV function and no valve disease. The main cause of PH is diastolic dysfunction associated to atrial fibrillation.