P1596 Pulmonary hypertension in cardiology practice: clinical echocardiographic evaluation

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Abstract Purpose To study the clinical echocardiographic features of various variants of pulmonary hypertension (PH). Methods of research. Clinical evaluation and analysis of the results of 45,000 Doppler echocardiographic studies were performed. Moderate PH corresponded to the mean pulmonary artery pressure (MPAP) level up to 50 mm Hg, severe PH was characterized by MPAP above 50 mm Hg. Results Clinically significant moderate and severe PH was established in 283 patients, which was 0.63% of the examined patients. Severe PH was detected in 106 patients, including 30 men and 76 women, whose average age was 43.1 ± 1.7 years in the age range of 14-75 years. Patients with congenital heart disease (CHD) represented the majority of the patients with severe pulmonary arterial hypertension (PAH) - 49 people (10 men and 39 women, mean age 43.0 ± 1.8 years in the age range of 14-69 years), including 16 with ventricular septal defect, 9 with an atrial septal defect, 7 with transposition of the great arteries, 6 with complete common atrioventricular canal defect, 3 with congenitally corrected transposition of the great arteries, 3 with a double outlet right ventricle, 3 with a common arterial trunk, 2 with the Ebstein anomaly. Severe PH was also established in 12 patients with idiopathic PAH, 21 patients with recurrent pulmonary embolism (PE), 10 with acquired valvular heart disease (AVHD) (in 7 cases with severe mitral stenosis, 3 with severe aortic stenosis), in 7 patients with postinfarction left ventricular aneurysm, 4 patients with chronic obstructive pulmonary disease (COPD), 3 with dilated cardiomyopathy. Moderate PH was diagnosed in 177 patients (97 men and 80 women, mean age 60.3 ± 1.3 years in the age range of 21-87 years), including 54 patients with dilated, 26 - ischemic cardiomyopathy, 38 with AVHD, 26 with PE, 17 post-MI patients, 9 with CHD, and 7 with COPD. PAH-specific therapy with bosentan and / or sildenafil was performed in 9 patients with idiopathic PAH and 7 patients with CHD without significant clinical effect; in other cases, nonspecific therapy was continued with diuretics, positive inotropic agents, and anticoagulants. Conclusions The most pronounced manifestations of PH were observed predominantly in CHD patients with advanced left-to-right and right-to-left shunting of blood, idiopathic PAH and thromboembolic PH. For prevailing venous PH, the less pronounced clinical manifestations were observed in patients with ischemic, non-coronary and valvular heart lesions, as well as with COPD accompanied by hypoxemia.