Pulmonary Hypertension: Incidence and Mortality in 13,448 Patients Investigated With Repeat Echocardiography

Abstract

We addressed the paucity of data describing the characteristics and natural history of incident pulmonary hypertension (PHT) using data from the National Echo Database of Australia (NEDA). Adults (n=13,448) undergoing routine echocardiography without evidence of PHT were studied. Subsequent age and sex-specific incident PHT were derived from echocardiograms conducted a median of 3.4 years apart. Progressive PHT severity (according to estimated right ventricular systolic pressure, eRVSP levels) and individually linked mortality were examined per PHT stage. A total of 6,169 men (45.9%, 61.4±16.7yrs) and 7,279 women (60.8±16.9yrs) with no initial evidence of PHT were identified (first echocardiogram). Subsequently, 5,412 (40.2%) developed PHT (repeat echocardiogram)—comprising 4,125 (30.7%), 928 (6.9%), and 359 (2.7%) cases of mild, moderate, and severe PHT, respectively. The incidence of all stages of PHT was 15.2 cases per million men/year and 12.5 cases per million women/year. Median eRVSP increased by +7.4 (IQR +4.6 to +10.1) mmHg in mild PHT compared to +30.7 (IQR +26.0 to +37.3) mmHg in severe PHT cases between first and last echocardiograms. During subsequent median 8.1yrs follow-up, 2,776 (20.6%) died from all-cause. Compared to no PHT, the adjusted risk of all-cause mortality was 1.35-fold higher in mild PHT, 1.94-fold higher in moderate PHT and 2.43-fold higher in severe PHT cases (all p<0.001). New onset of PHT is a common finding among older patients followed-up with echocardiography. Even milder stage of PHT is associated with higher mortality, reflecting the need to proactively evaluate symptoms consistent with PHT.