Prevalence Of Pulmonary Hypertension Research Articles

Prevalence of Pulmonary Hypertension among Sudanese Patients with Sickle Cell Disease

Background Sickle Cell Disease (SCD) is a hereditary condition characterized by aberrant red blood cell morphology, leading to persistent hemolytic anemia. The consequential impact of SCD on the pulmonary vasculature can result in pulmonary hypertension (PHT), a severe complication that detrimentally affects the well-being and survival of individuals with SCD. The prevalence and risk determinants of PHT in SCD patients exhibit variations across diverse geographical regions and populations. This study aims to ascertain the prevalence of PHT among Sudanese SCD patients and identify associated factors. Methods A cohort of thirty-one adult sickle cell disease (SCD) patients, as confirmed by hemoglobin electrophoresis, were recruited for participation in this cross-sectional study. Comprehensive data encompassing demographic, clinical, and laboratory parameters were collected. Doppler echocardiography was employed to quantify pulmonary arterial systolic pressure (PASP) and evaluate right ventricular size and function. Results Within our cohort, the prevalence of PHT was 29%. Active cigarette smoking demonstrated a significant association with PHT (P=0.042), while hydroxyurea therapy exhibited no noticeable impact on PHT (P=0.612). Conclusion Our investigation revealed a PHT prevalence of less than one-third in our SCD patient population, aligning with prior studies. Notably, independent of other factors, cigarette smoking emerged as a distinct risk factor for PHT in SCD patients. This highlights the potential utility of smoking cessation as an intervention to delay the onset of this condition. However, further research is imperative to elucidate the mechanisms through which smoking contributes to PHT development in individuals with SCD.

N-terminal pro-brain natriuretic peptide is associated with pulmonary hypertension or diastolic dysfunction in patients with systemic sclerosis: An Australian prospective cross-sectional study

Introduction: Pulmonary arterial hypertension and left ventricular diastolic dysfunction are associated with significant morbidity and mortality in systemic sclerosis. N-terminal pro-brain natriuretic peptide has been proposed as part of composite screening algorithms for pulmonary arterial hypertension. Our aim was to assess the prevalence of pulmonary hypertension and diastolic dysfunction, and evaluate their association with serum N-terminal pro-brain natriuretic peptide in systemic sclerosis patients. Methods: Patients with systemic sclerosis were prospectively enrolled to undergo N-terminal pro-brain natriuretic peptide testing and transthoracic echocardiography at a tertiary Australian centre from January to October 2022. We collected demographic and transthoracic echocardiography variables including pulmonary hypertension estimated by tricuspid regurgitant velocity and diastolic dysfunction assessed by the ASE/EACVI 2016 guidelines. Pearson’s correlation coefficient was used to evaluate association between N-terminal pro-brain natriuretic peptide and echocardiographic parameters. Results: Sixty-one patients were enrolled (median age = 62 years (interquartile range = 55–69 years); 84% female). Two-thirds of patients had limited systemic sclerosis (40/61). Five patients (8%) had high likelihood of pulmonary hypertension by transthoracic echocardiography. Seven patients (11%) had diastolic dysfunction; however, seven patients (11%) had indeterminate diastology. Six patients underwent right heart catheterisation, with five patients diagnosed with pulmonary hypertension. N-terminal pro-brain natriuretic peptide in patients with pulmonary hypertension or diastolic dysfunction was significantly higher (median = 207 and 226 pg/mL, respectively) compared to patients without either condition (median = 69 pg/mL, p = 0.01). N-terminal pro-brain natriuretic peptide showed a statistically significant although limited correlation with estimated pulmonary pressures measured by tricuspid regurgitant velocity (r = 0.44, p = 0.002) and left ventricular filling pressures (r = 0.27, p = 0.04). Conclusion: Pulmonary hypertension and diastolic dysfunction are both observed in systemic sclerosis. N-terminal pro-brain natriuretic peptide is associated with both conditions; however, it cannot distinguish between the two disease processes. Right heart catheterisation may be required to make this distinction.

Prevalence of Pulmonary Hypertension in Liver Cirrhosis Patients: A Cross-Sectional Analytical Study.

Liver cirrhosis (LC) is a common complication of chronic liver disease. Its prevalence has increased markedly over the last few years. With liver cirrhosis comes cardiovascular morbidity and mortality. It is important that the detection of the abnormalities by echocardiography be given priority, as this can change the clinical outcome of these patients with cardiovascular abnormalities in liver cirrhosis. This study aims to determine the prevalence of pulmonary hypertension in LC patients. A cross-sectional analytical study was carried out at JUTH (Jos University Teaching Hospital) over a period of one year. We recruited 210 adult patients with liver cirrhosis from the gastroenterology clinic and wards for this study. Data from these patients were collected with questionnaires administered by the interviewer and analysed using SPSS 23 statistical software (IBM Corp., Armonk, NY). The data obtained are presented in tables and charts. Categorical variables were expressed as proportions and frequencies, while continuous data were expressed as the median, mean, and standard deviation. Pulmonary hypertension was found in 30.5% of the participants, with mild pulmonary hypertension being the most common. No one had severe pulmonary hypertension. There was an increased risk of developing pulmonary hypertension in patients with coughs, easy fatigability, bilateral leg swelling, abdominal swelling, and ascites (P<0.05). The result showed that there is a high prevalence of pulmonary hypertension in patients with liver cirrhosis.

Impact of preoperative persistent or permanent atrial fibrillation on inhospital mortality after coronary artery bypass graft surgery

Introduction: Atrial fibrillation (AF) is an arrhythmia that has a well-established impact on cardiovascular and cerebrovascular morbidity and mortality. However, the role of this arrhythmia plays on surgical risk remains uncertain. Objective: to evaluate the impact of preoperative persistent or permanent AF on in-hospital mortality after isolated coronary artery bypass graft surgery (CABG). Methods: prospective cohort with 2,377 patients submitted to isolated CABG between January 2014 and December 2021. Sixty-two variables, including baseline factors, operative characteristics, and outcomes, were analyzed. Patients were divided into two study groups: No preoperative AF (n=2,287) and preoperative persistent or permanent AF (N=90). The comparison between the groups was performed initially by descriptive and univariate analysis. Subsequently, the analysis of mortality predictors was performed using binary logistic regression - multivariate adjusted analysis. Results: patients with preoperative AF were older, had a higher prevalence of pulmonary hypertension and anemia, had lower ejection fraction and had higher surgical risk scores when compared with patients with no history of atrial fibrillation. The in-hospital death was more frequent in patients with a history of AF (3.2% vs 8.9%, P=0.010). Through the multivariate analysis, it was possible to verify that preoperative AF is independently associated with the occurrence of in-hospital mortality after CABG (OR 2.68; 95% CI 1.21-5.94, P=0.015). Conclusion: Preoperative persistent or permanent AF has been shown to have a significant impact on in-hospital mortality rates after CABG even after adjusted multivariate analysis, being an independent risk predictor for the occurrence of postoperative death.

IDF23-0066 Prevalence of pulmonary hypertension in patients with diabetic kidney disease

IDF23-0066 Prevalence of pulmonary hypertension in patients with diabetic kidney disease

Prevalence of pulmonary hypertension in children with obstructive sleep apnea living at high altitude

IntroductionThe prevalence of obstructive sleep apnea (OSA) is 1–4 %. Some reports describe its association with pulmonary hypertension (PH), but its prevalence is unknown. No studies at high altitude have determined the relationship between OSA and PH. The aim of this study was to establish the prevalence of PH in children diagnosed with OSA living in a high-altitude city at 2640 m above sea level. MethodsChildren between 2 and 16 years of age referred to the Sleep Laboratory of the Fundación Neumológica Colombiana in Bogotá with a positive polysomnogram for OSA were included, and a two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate PH. Statistical analysis was performed using median, interquartile range, chi-squared test, and Kruskall-Wallis test. ResultsOf the 55 patients (n: 55), 63.6 % were male, with a median age of 6 years, 14 children (25.5 %) were overweight; 12 children (21.8 %) had mild OSA, 12 (21.8 %) had moderate OSA and 31 (56.4 %) severe OSA. In patients with severe OSA, the minimum saturation during events was 78 % with a desaturation index (DI) of 33.8/hour (p < 0.01). T90 and T85 increased proportionally with OSA severity (p < 0.05). Of the 55 patients with OSA, none had PH according to echocardiography; 4 patients (7.2 %) had pulmonary artery systolic pressure (PASP) at the upper limit of normal (ULN), and it was not related to a higher body mass index (BMI). ConclusionsWe found no association between OSA and PH in children with OSA at high altitude.

The prevalence of pulmonary hypertension in post-tuberculosis and active tuberculosis populations: a systematic review and meta-analysis.

The prevalence of tuberculosis (TB)-associated pulmonary hypertension (PH) has not previously been quantified, resulting in an underappreciated burden of disease. We aimed to estimate the prevalence of PH in post-TB and active TB populations. In this systematic review and meta-analysis, we searched PubMed/Medline, Cochrane Library, EBSCOhost, Scopus, African Journals Online and Google Scholar, with no language restriction, for available literature published after 1950. Eligible studies described adult participants (≥16 years), with documented evidence of active or prior TB, diagnosed with PH. Study quality was assessed using a risk of bias tool specifically developed for prevalence studies. Aggregate prevalence estimates with 95% confidence intervals were synthesised using a random-effects meta-analysis model, incorporating the Freeman-Tukey transformation. Subgroup analysis was conducted to ascertain prevalence estimates in specific patient populations. We identified 1452 unique records, of which 34 met our inclusion criteria. 23 studies, with an acceptable risk of bias and where PH was diagnosed at right heart catheterisation or echocardiography, were included in the meta-analysis. In post-TB studies (14/23), the prevalence of PH was 67.0% (95% CI 50.8-81.4) in patients with chronic respiratory failure, 42.4% (95% CI 31.3-54.0) in hospitalised or symptomatic patients and 6.3% (95% CI 2.3-11.8) in nonhealthcare-seeking outpatients (I2=96%). There was a lower estimated prevalence of PH in studies of populations with active TB (9.4%, 95% CI 6.3-13.0), I2=84%). Our results highlight the significant burden of PH in post-TB and active TB populations. We emphasise the need for increased recognition of TB-associated PH and additional high-quality prevalence data.

Assessment of the prevalence of pulmonary hypertension and volume status in Regular hemodialysis patients

Assessment of the prevalence of pulmonary hypertension and volume status in Regular hemodialysis patients

Pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease.

Objective: To establish the frequency in regards to pulmonary hypertension within individuals suffering from chronic obstructive pulmonary disease. Study Design: Cross-sectional study. Setting: Pulmonology Division of Jinnah Hospital Lahore. Period: January, 2023 to April, 2023. Material &amp; Methods: A total of 200 patients of both male and female patients with age from 40 to 70 years having chronic obstructive pulmonary disease were included by nonprobability consecutive sampling. Patients with history of other respiratory disease like interstitial lung disease, bronchiectasis, allergic broncho-pulmonary aspergillosis (ABPA), sarcoidosis, occupational lung diseases, asthma, ischemic heart disease, pulmonary hypertension, collagen vascular disease were factored out of the study. Cardiac echocardiography was performed in all the patients and pulmonary hypertension as assessed. Results: In this study, 87 (43.5%) were between 40-55 years of age while 113 (56.5%) were within the ages of 56-70, and thus the mean age was 57.28±8.44 years. 131 (65.5%) patients were male and 69 (34.5%) were females. 49 (24.5%), 103 (51.5%) and 48 (24%) patients had mild, moderate and severe COPD respectively. Pulmonary hypertension was found in 105 (52.5%) patients. Pulmonary hypertension is more prevalent in severe cases of COPD than mild and moderate patients with p-value = 0.0001. Conclusion: Patients with chronic obstructive lung disease have a high prevalence of pulmonary hypertension. This is shown to be more common within patients suffering from severe cases of COPD.

Pulmonary and Systemic Hemodynamics in Patients with Hyperthyroidism

BackgroundThere is an association between hyperthyroidism and pulmonary hypertension. However, the prevalence of pulmonary hypertension in hyperthyroidism and the underlying mechanisms are incompletely defined. MethodsConsecutive patients with severe hyperthyroidism, mostly due to Graves disease, were included in this single-center study. Echocardiographic assessment of pulmonary hemodynamics was performed at the time of hyperthyroidism diagnosis (baseline) and after normalization of thyroid hormones (follow-up; median 11 months). In a subset of patients, right heart catheterization and noninvasive assessment of central hemodynamics was performed. ResultsAmong all 99 patients, 31% had pulmonary hypertension at baseline. The estimated systolic pulmonary artery pressure correlated significantly with the estimated left ventricular filling pressure (E/e′). The invasively measured systolic pulmonary artery pressure correlated well with the estimated systolic pulmonary artery pressure. Cardiac output, E/e′, left and right ventricular dimensions were significantly reduced from baseline to follow-up, whereas the estimated pulmonary vascular resistance did not differ. Diastolic blood pressure was significantly higher at follow-up, with no change in systolic blood pressure. The central systolic blood pressure, however, exhibited a trend for a reduction at follow-up, while the pulse wave velocity was significantly lower at follow-up. ConclusionsApproximately one-third of patients with hyperthyroidism have evidence of pulmonary hypertension. Our data suggest that an increased cardiac output and left ventricular filling pressure are the main mechanisms underlying the elevated systolic pulmonary artery pressure in hyperthyroidism, whereas there is no evidence of significant pulmonary vascular disease.

Prevalence of pulmonary hypertension in obstructive sleep apnea and its relation to disease severity.

The purpose of this study is to examine the prevalence of pulmonary hypertension (PHTN) in children with obstructive sleep apnea (OSA) using echocardiographic (ECHO) parameters and to examine ECHO findings as they relate to severity of OSA. A retrospective cohort study of patients with OSA undergoing polysomnogram and ECHO within 30 days of each other, between January 1, 2015, and December 31, 2020, was performed, excluding cardiac disease. ECHO evidence of PHTN was defined as ≥ 2 of the following: tricuspid regurgitation velocity > 3.0 m/s, pulmonary acceleration/ejection time ratio < 0.3, left ventricular eccentricity index > 1.5, and right ventricular dysfunction or abnormal geometry. ECHO parameters were compared to OSA severity using obstructive apnea-hypopnea index, percent of time with oxygen saturation < 90%, and percent of time with end-tidal carbon dioxide > 50 mmHg. Odds ratios were calculated for each comorbidity to evaluate for risk factors. Of 509 patients, 4.3% were found to have echocardiographic evidence of PHTN. Neither obstructive apnea-hypopnea index severity nor worsening hypoxemia or hypercarbia correlated with worsening ECHO parameters. Comorbidities including bronchopulmonary dysplasia (odds ratio, 5.22, 2.01-13.53), prematurity (odds ratio, 3.10, 1.28-7.47), and autism (odds ratio, 3.69, 1.01-13.49) were associated with increased odds of PHTN. Significant echocardiographic evidence of PHTN was seen in 4.3% of children with OSA. ECHO findings of PHTN did not correlate with polysomnogram parameters. Comorbidities, particularly bronchopulmonary dysplasia, prematurity, and autism, appear to be a risk factor for developing PHTN in patients with OSA. Milligan I, Shaw AK, Leu R, Kanaan U, Michelfelder E. Prevalence of pulmonary hypertension in obstructive sleep apnea and its relation to disease severity. J Clin Sleep Med. 2024;20(5):675-680.

Prevalence of pulmonary hypertension and WHO classification among young patients

Prevalence of pulmonary hypertension and WHO classification among young patients

Prevalence of pulmonary hypertension and WHO classification among young patients

Prevalence of pulmonary hypertension and WHO classification among young patients

Prevalence of pulmonary hypertension in chronic simple silicosis patients and its correlation with smoking history, occupation type, age and duration of silica exposure.

Silicosis is a preventable occupational health hazard with potential for permanent physical disability and increased socio-economic burden. Pulmonary hypertension (PH) secondary to chronic respiratory diseases signifies poorer prognosis and transthoracic echocardiography (TTE) has proven its usefulness as a screening tool for PH diagnosis. The objectives were to determine PH prevalence in chronic simple silicosis patients through TTE screening and correlate PH prevalence with smoking status, occupation type, age and duration of silica exposure (DSE). We enrolled 104 patients in the study based on occupational exposure to silica dust and radiologic confirmation of chronic simple silicosis. The study sample was divided into significant smokers (SS group) and insignificant smokers (InS group) on the basis of ≥10 pack years smoking history, and into drillers and dressers based on occupation type. TTE examination was performed to measure resting mean pulmonary artery pressure (mPAP) and the patients were classified into: no PH (mPAP≤20 mm Hg), borderline PH (mPAP>20 and <25 mmHg), and PH (mPAP≥25). PH prevalence was 25% in study subjects (26/104); 29.6% (16/54) among SS group versus 20% (10/50) among InS group (.52) ; and 34.2% (14/41) among drillers versus 19.1% (12/63) among dressers (p=.024). Mean age and mean duration of silica exposure among SS and InS groups were comparatively similar, while they had lower values among dressers against dressers with no statistical significance. Logistic regression analysis established a significant association of PH prevalence with higher age in the study sample, SS group and drillers group, while a significant association of PH prevalence with longer DSE was only seen in the study sample. PH prevalence was significantly associated (p=.007) with SS-driller group on comparing TTE findings with combined smoking and occupation type based groups. This study has shown PH prevalence in chronic simple silicosis patients at alarming levels, having associations with driller occupation, older age and longer DSE with varying results among groups and complex interplay with smoking exposure, suggesting the need for large sample-based molecular and genetic studies. Including TTE in the initial work-up of silicosis patients will promote timely intervention and reduce morbidity and mortality with a high benefit-cost ratio.

Prevalence of pulmonary hypertension in reduced left ventricular systolic function and its influence on outcomes

Abstract Background/Introduction Reduced left ventricular (LV) systolic function can lead to pulmonary hypertension (PHT). However, the significance of PHT complicating reduced LV systolic function remains poorly characterised. Purpose We aimed to describe the prevalence and prognostic importance of PHT in a large cohort of adults with at reduced left ventricular ejection fraction (LVEF). Methods We analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with a recorded tricuspid regurgitation (TR) peak velocity and LVEF &amp;lt;50% were included. Patients with moderate or greater left sided valvular pathology were excluded, as were patients with prior aortic or mitral valve replacements. These subjects (n= 23675) were then categorised according to their TR peak velocity. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 2.9 years, interquartile range 1.0-5.4years). Results Subjects were aged 70±15years and 31.7% were female. Overall, 8801 (37.2%), 7061 (29.8%), 5676 (24.0%), and 2137 (9.0%) patients had normal (TR peak velocity &amp;lt;2.5m/sec), borderline (2.5-2.8m/sec), intermediate (2.9-3.4m/sec), or high risk PHT (&amp;gt;3.4m/sec), respectively. An echocardiographic phenotype for ‘left heart disease’ was evident with worsening PHT, showing rising E:e’ ratio and a greater proportion of right ventricular (RV) dilation and dysfunction (p&amp;lt;0.0001 for all). Left and right atrial sizes increased from low-intermediate risk, before plateauing at high risk PHT (p&amp;lt;0.0001). With increasing risk of PHT, 1- and 5-year actuarial mortality increased from 13.3% and 43.8%, to 41.5% and 81.4% respectively (p&amp;lt;0.0001). After adjustment for age, sex, LVEF, LV end diastolic diameter and LA volume index, the risk of mortality increased as TR peak velocity increased (adjusted hazard ratio (aHR) 1.31, 95% confidence interval 1.23-1.38 in borderline risk, to aHR2.38, 95%CI 2.21-2.56 in high risk PHT) (Figure 1). The cohort was also assessed in two groups based on LVEF severity according to guidelines. The sub-group of patients with mildly reduced LVEF (40-49%, n = 12495) showed that mortality risk increased as risk of PHT increased; (aHR 1.38, 95%CI 1.27-1.50 in borderline risk, to aHR2.82, 95%CI 2.52-3.15 in high risk PHT). Similarly, those with reduced LVEF (&amp;lt;40%, n = 11180) mirrored these trends (aHR 1.23, 95%CI 1.14-1.33 in borderline risk, to aHR2.07, 95%CI 1.88-2.28 in high risk PHT). There was a mortality threshold seen from TR peak velocity 2.41m/sec onwards (aHR1.18, 95%CI 1.04-1.33) (Figure 2). Conclusion(s) In this large cohort study, we demonstrate that PHT risk is common in patients with reduced LV systolic function and mortality increases as PHT becomes more severe. A threshold for higher mortality lies within the range of "borderline-intermediate" risk PHT.Adjusted Risk for All-Cause MortalityThreshold for Mortality

Prevalence of pulmonary hypertension in aortic stenosis and its influence on outcomes

Abstract Background Aortic stenosis (AS) is the commonest valve abnormality in developed countries with increasing prevalence and a long pre-symptomatic phase. Measurable variables are likely important in stratifying risk and potentially guiding management decisions. The significance of Pulmonary Hypertension (PHT) complicating AS is poorly characterised. Purpose We aimed to describe the prevalence and prognostic importance of PHT in a large cohort of adults with at least moderate AS. Methods In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) &amp;gt;50% and with moderate or greater AS were included (n= 14980). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 2.6 years, interquartile range 1.0-4.6 years). Results Subjects were aged 77±13years and 57.4% were female. Overall, 2049 (13.7%), 5085 (33.9%), 4380 (29.3%), 1956 (13.1%) and 1510 (10.1%) patients had no (eRVSP&amp;lt;30.00mmHg), borderline (30.00-39.99mmHg), mild (40.00-49.99mmHg), moderate (50.00-59.99mmHg) and severe PHT (&amp;gt;60.00mmHg), respectively. A echocardiographic phenotype was evident with worsening PHT, showing rising E:e’ ratio and right and left atrial sizes (p&amp;lt;0.0001, for all). After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted hazard ratio (aHR) 1.15, 95% confidence interval 1.05-1.26 in borderline PHT, to aHR3.04, 95%CI 2.74-3.36 in severe PHT) (Figure 1). These trends were maintained on a sensitivity analysis excluding patients with ≥moderate mitral and/or aortic regurgitation (n=12005), (aHR 1.12, 95% CI 1.002-1.24 in borderline PHT, to aHR3.00, 95%CI 2.66-3.39 in severe PHT). A mortality threshold was identified in the 4th decile of eRVSP categories (35.01–38.00mmHg; HR1.20, P=0.005), with risk progressively increasing through to the 10th decile (HR2.95 p &amp;lt;0.0001). Conclusions Both AS and PHT confer an increased risk of mortality as they progress. In this large cohort study, we find that PHT is common in ≥moderate AS and mortality increases as PHT becomes more severe. A threshold for higher mortality lies within the range of "borderline-mild" PHT.Adjusted Risk for All-Cause MortalityThreshold for Mortality

Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes

Abstract Background Pulmonary hypertension (PHT) is known to complicate left heart diseases (LHD) including left sided valvular pathologies such as aortic regurgitation (AR). However, there is a paucity of data on the prognostic importance of PHT in AR patients. Purpose We aimed to describe the prevalence and prognostic importance of PHT in adults with "isolated" ≥ moderate AR. Methods In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) &amp;gt;50%, with moderate or greater AR and without severe aortic stenosis or prior aortic valve replacement, were included (n= 8392). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.1 years, interquartile range 1.5-5.7 years). Results Subjects were aged 74±14 years and 58.4% (4901) were female. Overall, 1417 (16.9%) had no PHT (eRVSP&amp;lt;30.00mmHg); and 3253 (38.8%), 2249 (26.9%), 893 (10.6%) and 580 (6.9%) had borderline (30.00-39.99mmHg), mild (40.00-49.99mmHg), moderate (50.00-59.99mmHg) or severe PHT (&amp;gt;60.00mmHg), respectively. Mean eRVSP was slightly higher in females than males (41±13 vs 39±12mmHg, p&amp;lt;0.0001) and increased with age in both sexes. A typical phenotype of "left heart disease" was evident with E:e’ and the proportion of patients with RV functional impairments increasing progressively, from no PHT to severe PHT (p&amp;lt;0.0001, for all). After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted hazard ratio (aHR) 1.20, 95% confidence interval 1.06-1.36 in borderline PHT, to aHR3.32, 95%CI 2.85-3.86 in severe PHT) (Figure 1). These trends were maintained on a sensitivity analysis excluding patients with ≥moderate mitral regurgitation (n=6753), though only became significant from mild PHT onwards (aHR 1.13, 95% CI 0.98-1.30 in borderline PHT, to aHR3.51, 95%CI 2.94-4.18 in severe PHT). Using decile distribution of eRVSP a mortality threshold seen from mild PHT onwards (eRVSP 41.36-44.15mmHg; aHR1.41, 95%CI1.17-1.68) (Figure 2). Conclusions In patients with ≥moderate AR, PHT is associated with a progressive risk of mortality, even in those with mild PHT.Adjusted Risk for All-Cause MortalityThreshold for Mortality

Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes

Abstract Background Pulmonary hypertension (PHT) commonly co-exists with significant mitral regurgitation (MR), but its prevalence and prognostic importance has not been well documented. Purpose In a large cohort of adults with ≥moderate MR, we aimed to describe the prevalence and severity of PHT and assess its influence on outcomes. Methods We analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) &amp;gt;50% and with moderate or greater MR were included (n= 9683). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.2 years, interquartile range 1.3-6.2years). Results Subjects were aged 76±12years and 62.6% (6038) were female. Overall, 959 (9.9%) had no PHT; and 2952 (30.5%), 3167 (32.7%), 1588(16.4%) and 1017 (10.5%) patients had borderline, mild, moderate and severe PHT respectively. A "typical left heart disease" phenotype was identified with worsening PHT, showing rising E:e’, right and left atrial sizes increasing progressively, from no PHT to severe PHT (p&amp;lt;0.0001, for all). With increasing PHT severity, 1- and 5-year actuarial mortality increased from 8.5% and 39.7%, and from to 33.0% and 79.8% respectively (p&amp;lt;0.0001). Similarly, adjusted survival analysis showed the risk of long-term mortality progressively increased with higher eRVSP levels (adjusted hazard ratio (aHR) 1.20, 95% confidence interval 1.04-1.38 in borderline PHT, to aHR2.86, 95%CI 2.48-3.31 in severe PHT, p&amp;lt;0.0001) (Figure 1). A mortality inflection was apparent at an eRVSP level &amp;gt;34.00mmHg (HR1.27, CI1.00-1.36) (Figure 2). Conclusions In this large study we characterise the close but incompletely understood relationship between significant MR and complicating PHT. Mortality increases as PHT becomes more severe from an eRVSP of approximately 34mmHg onwards.Adjusted Risk for All-Cause MortalityThreshold for Mortality

The Prevalence of Pulmonary Hypertension in Beta-Thalassemia Patients in Hormozgan Province: A Cross-sectional Study

Background: Pulmonary hypertension (PH) is associated with an increased risk of cardiac failure among asymptomatic patients with beta-thalassemia. This study aimed to determine the prevalence of PH and associated risk factors in patients with beta-thalassemia major (TM) and beta-thalassemia intermedia (TI) in Hormozgan province, Iran. Materials and Methods: Eighty-nine patients, including 65 TM and 24 TI, were enrolled in this cross-sectional study. The data regarding the gender, age, history of splenectomy, and type of chelating therapy were collected, and then hematocrit, hemoglobin (Hb), and serum ferritin levels were determined. Doppler echocardiography was performed for patients, and tricuspid regurgitation jet velocity (TRV)≥2.5 m/s was used to screen PH. Eventually, the data were analyzed using SPSS. Results: The prevalence of TRV≥2.5 m/s was 21.3% in all patients, indicating that it was not significantly different between patients with TM (21.8%) and TI (20.8%). There was a significant association between the prevalence of PH and the male gender. Based on the results, TRV≥2.5 m/s was observed in both children and adults. No significant association was detected between Hb, serum ferritin levels, and splenectomy with PH prevalence. Conclusion: The findings revealed that PH is common in both children and adult patients with TM and TI in our population and should be considered to choose the optimal treatment of patients with TM and TI.

Pulmonary Artery Pressure Status in Hemodialysis Patients and Its Association with Nutritional and Biochemical Markers

Background: The prevalence of pulmonary hypertension (PH) is reported between 17% and 56% in hemodialysis patients. The pathogenesis of PH in hemodialysis patients is still unclear. Malnutrition may be associated with impaired pulmonary function in hemodialysis patients. Objectives: The present study aimed to investigate the association between PH and nutritional and biochemical markers in hemodialysis patients. Methods: In this cross-sectional study, 80 patients undergoing hemodialysis at the Kowsar Medical Center, Semnan, Iran, from 1 March 2016 to 31 August 2016 were enrolled by complete enumeration. Pulmonary artery pressure was determined by echocardiography between hemodialysis sessions. Arm circumference, triceps fat mass, and body mass index (BMI) were determined. Other laboratory tests included transferrin, serum albumin, cholesterol, triglyceride, and hemoglobin. The source of receiving protein was recorded in a questionnaire. The data were analyzed by the chi-square test and logistic regression analysis at a significance level of less than 0.05. Results: Pulmonary hypertension ( &gt; 25 mmHg) was found in 32 (40%) of the 80 patients studied. The mean of pulmonary pressure in patients with PH was 34.66 ± 5.6 mmHg compared to 16.85 ± 3.7 mmHg in patients without PH. Age, gender, arm circumference, frequency of dialysis per year, and serum levels of albumin, transferrin, triglyceride, and total cholesterol were not significantly different between patients with and without PH. There was a significant difference in the mean hemoglobin level between patients with and without PH (P = 0.003). The likelihood of developing PH was reduced by 0.3 in those with hemoglobin ≥ 11 g/dL compared to patients with hemoglobin levels below 11 g/dL (OR = 0.400, P = 0.003). The likelihood of developing PH in patients with albumin ≥ 3.8 g/L decreased by 0.126 compared to those with albumin less than 3.8 (OR = 0.126, P = 0.003). Conclusions: The results of our study indicated a higher incidence of PH in patients with lower levels of hemoglobin and albumin. So, patients undergoing hemodialysis are recommended to be regularly screened for these two variables.