Prevalence Of Pulmonary Hypertension Research Articles

The Incidence and Prevalence of Pulmonary Hypertension in the COPD Population: A Systematic Review and Meta-Analysis

PurposeChronic obstructive pulmonary disease (COPD)-related pulmonary hypertension (PH) is one of the most common comorbidities of COPD, and often leads to a worse prognosis. Although the estimated prevalence and risk factors of COPD-related PH have been widely reported, these results have not been well integrated. This study aimed to review the worldwide incidence and prevalence of COPD-related PH and explore possible factors affecting its prevalence.Patients and MethodsWe searched four electronic databases (Web of Science, Embase, Cochrane, and MEDLINE) to identify all observational studies on the prevalence of COPD-related PH from database creation until July 20, 2021. Eligibility screening, quality assessment, and data extraction of the retrieved studies were independently conducted by two reviewers. Meta-analyses were performed to determine the prevalence of PH in the COPD population. Random-effects meta-regression model analyses were conducted to investigate the sources of heterogeneity.ResultsAltogether, 38 articles were included in the meta-analyses. The pooled prevalence was 39.2% (95% CI: 34.0–44.4, I2 = 97.6%) for COPD-related PH. Subgroup analyses showed that the prevalence of PH increased with COPD severity, where the majority (30.2%) had mild PH and the minority had severe PH (7.2%). Furthermore, we found a significant regional difference in the prevalence of COPD-related PH (P = 0.000), which was the highest in Africa (64.0%) and the lowest in Europe (30.4%). However, stratified studies on other factors involving mean age, sex, enrolment time, participant recruitment settings, and PH diagnostic methods showed no significant differences in prevalence (P >0.05).ConclusionThe global incidence of PH in the COPD population is very high, and there are significant regional and international variations. Patients with COPD should be screened for PH and contributing risk factors to reduce the burden on individuals and society.

PREVALENCE OF PULMONARY HYPERTENSION IN CHRONIC KIDNEY DISEASE

Background: Pulmonary hypertension (PH) is a recently recognized complication of chronic kidney disease (CKD), especially in end-stage renal disease. Cardiovascular disease is the most important cause of morbidity and mortality in CKD. This study was done to assess the prevalence of Pulmonary Hypertension in CKD patients and to assess the severity of Pulmonary Hypertension in different stages of CKD. The studyMaterials And Methods: was performed on 140 patients. At M. L. N. medical college prayagraj. All patients were evaluated by clinical, laboratory and imaging. All patients were subjected to echocardiography for assessment of Pulmonary arterial Hypertension. A totalResults: of 140 patients were included. Mean age of statics was 55.61±11.65 years. Male: Female was 2.33:1. Out of 140 study subjects, PH was found in 45 patients (32.1%.). Amongst which 26 had mild PH, 13 moderate and 6 had severe PH. Prevalence of Severe PH was signicantly higher in stage 5 CKD subjects (23.5%) compared to stage 3(1.3%) & 4(2.3%). As CKD progressesConclusion: the prevalence and severity of PH increases.

Abstract 57: Impact Of Body Mass Index In Functional Capacity And Hemodynamics In Patients With Pulmonary Arterial Hypertension

Background: Prior studies demonstrate a higher prevalence of pulmonary hypertension (PH) and more severe hemodynamics in patients with higher body mass index (BMI). However, this association was only described in post-capillary PH. To better understand the relationship between pre-capillary PH and BMI, we compared various PH parameters stratified by BMI class. Methods: Data from right heart catheterization (RHC), 6-minute walk (6MW), and functional class (FC) were collected from the University of Michigan Pulmonary Hypertension Patient Registry from 2016-2020 at baseline and 3-month follow-up. Group 1 pulmonary arterial hypertension (PAH) patients were grouped into 4 BMI weight classes: under/normal weight (BMI < 25), overweight (25 < BMI < 30), obesity class 1 (30 < BMI < 35), obesity class 2/3 (BMI > 35). Results: Among 175 PAH patients, obese patients exhibited higher right atrial and pulmonary capillary wedge pressures. There were no major differences in mean pulmonary artery (PA) pressures, pulmonary vascular resistance (PVR), cardiac index Fick, 6MW distance walked, or peak Borg Dyspnea score among BMI groups. Despite having similar mean PA pressure and PVR (major determinants of functional capacity in PAH), patients in higher weight classes had higher dyspnea symptom burden by WHO FC. Specifically, a greater prevalence of normal/overweight patients were in FC 1 while more obese patients were in FC 3. Conclusions: Overall, in patients with PAH, higher BMI classes presented with worse FC for dyspnea, higher RA and PCW pressures, with similar PA pressures and 6MW results. Our data suggests that BMI may be an important factor that influences PAH symptoms. The impact of BMI in PAH outcomes is yet to be determined. It is possible that patients with higher BMI may exhibit more frequent comorbid conditions contributing to multifactorial symptoms of dyspnea; further study is warranted.

Pulmonary hypertension in children with severe OSA: Can CO2 provide a clue?

Pulmonary hypertension in children with severe OSA: Can CO2 provide a clue?

Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea.

Pulmonary hypertension (PH) is a rare yet serious complication of obstructive sleep apnea (OSA). Echocardiographic screening for PH is recommended in children with severe OSA, but the health care burden of universal screening is high. We sought to determine the prevalence of PH on echocardiogram among children with severe OSA and identify variables associated with a positive PH screen. Retrospective study of 318 children with severe OSA (obstructive apnea-hypopnea index ≥ 10 events/h) and echocardiogram within 1 year of polysomnogram. PH-positive echocardiogram was defined by peak tricuspid regurgitation velocity ≥ 2.5 m/s and/or 2 or more right-heart abnormalities suggestive of elevated pulmonary artery pressure. Patient characteristics and polysomnogram data were compared to identify factors associated with PH. Twenty-six children (8.2%; 95% confidence interval [CI] 5.4-11.8%) had echocardiographic evidence of PH. There was no difference in age, sex, body mass index, obstructive apnea-hypopnea index, or oxygenation indices between patients with and without PH. Sleep-related hypoventilation (end-tidal CO2 > 50 mmHg for > 25% of total sleep time) was present in 25% of children with PH compared with 6.3% of children without PH (adjusted prevalence ratio = 2.73; 95% CI 1.18-6.35). Forty-six percent of children (12/26) with PH had Down syndrome vs 14% (41/292) without PH (adjusted prevalence ratio = 3.11; 95% CI 1.46-6.65). There was a relatively high prevalence of PH on echocardiogram in our cohort of children with severe OSA. The findings of increased PH prevalence among children with sleep-related hypoventilation or Down syndrome may help inform the development of targeted screening recommendations for specific pediatric OSA populations. Maloney MA, Davidson Ward SL, Su JA, etal. Prevalence of pulmonary hypertension on echocardiogram in children with severe obstructive sleep apnea. J Clin Sleep Med. 2022;18(6):1629-1637.

Clinicopathologic features, comorbid diseases, and prevalence of pulmonary hypertension in dogs with bronchomalacia.

BackgroundReports of clinicopathologic features of bronchomalacia (BM) differ because of inconsistent definitions and frequent prevalence of comorbid cardiopulmonary disease. Pulmonary hypertension (PH) secondary to BM is poorly described.ObjectivesDogs with BM will be older but of any somatotype, and increased expiratory effort, ≥1 comorbid disease, and PH will be more common than in dogs without BM.AnimalsClient‐owned dogs (n = 210) evaluated for respiratory signs.MethodsMedical records of dogs with paired inspiratory: expiratory‐breath‐hold computed tomography, tracheobronchoscopy, or both between January 2016 and December 2019 were retrospectively reviewed. Comparisons between dogs with and without BM using Mann‐Whitney rank sum or χ 2 tests (P < .05 significant were made). Because of high numbers of variables, criteria with high prevalence (>25%) were identified (n = 10) for univariate analysis (P < .005 significant). Significant variables were submitted for multivariate analysis.ResultsBronchomalacia was identified in 41% of dogs of all sizes/somatotypes; 38% were >10 kg. All dogs with BM had ≥1 comorbid cardiopulmonary disorder. Dogs with BM were significantly older (P < .001), smaller (P < .001), and were more likely diagnosed with tracheal or mainstem bronchial collapse (P < .001) or bronchiectasis (P < .001). Multivariate analysis confirmed associations with age, tracheal or mainstem bronchial collapse, and bronchiectasis. In dogs with BM, PH was more prevalent.Conclusions and Clinical ImportanceAlthough significantly more common in older, smaller dogs, BM occurs in dogs of all sizes and in all instances with comorbidities. Echocardiography should be considered in dogs with BM to identify PH.

Prognostic value of incidental finding of pulmonary hypertension detected by echocardiography in patients without known cardiovascular or pulmonary disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The estimated overall prevalence of pulmonary hypertension (PHT) is ∼1% in the global population, and up to 10% among patients older than 65 years. PHT is associated with a worst prognosis in patients with cardiovascular or pulmonary disease. However, the significance of PHT as an incidental finding among subjects who do not suffer from cardiac or pulmonary diseases is unknown. The aim of our study is to examine whether incidental diagnosis of PHT in patients without cardiovascular or pulmonary comorbidity is associated with long-term all-cause mortality. Methods This retrospective cohort study included 8296 patients (58% females, mean age, 63 ± 14 years), who performed a first echo study (echo 1) in the years 2006-2009 and a follow up study (echo 2) until 01/2020 in a large single center echo-lab. Patients were excluded if they had evidence of moderate or more left ventricular dysfunction (LVD), significant valvular disease or diagnosis of pulmonary disease at echo 1. The association between PHT and LV function degree (Ejection fraction above or below 55%) to all-cause mortality was examined between four groups [group 1 (G1)- normal LV function (NLV)+ no PTH (NPH), G2- LVD and NPH, G3- NLV and PHT, G4- LVD and PHT] using a Kaplan-Meier analysis and Cox proportional-hazards model, accounting for various covariates. Results Survival time of patients with or without PHT in echo 1 and LV function status at echo 2 was found significantly different among all groups (Pv &amp;lt; 0.001 for all comparisons) (Figure 1). Patients in G1 had the longest mean survival time (141 ± 23 months) compared to any other group (G2-134 ± 30 months, G3-129 ± 32 months, G4-119 ± 38 months). In the multivariable analysis conducted (Table 1), PHT adjusted for various demographic factors and comorbidities was found to be an independent risk factor for long term all-cause mortality with increased risk of up to 34% (adjusted HR-1.34; 95% CI: 1.21-1.47, PV &amp;lt; 0.001). Conclusion Incidental finding of PHT in patients without known cardiovascular or pulmonary disease is an independent risk factor for long term all-cause mortality. Future studies should be conducted to assess the impact of an early diagnosis on all-cause mortality, and the need for further diagnostic and therapeutic steps. Abstract Figure. Abstract Figure.

POS-235 PREVALENCE AND PREDICTORS OF PULMONARY HYPERTENSION IN CKD 3b-5ND PATIENTS-A SINGLE CENTRE EXPERIENCE FROM A DEVELOPING COUNTRY

Pulmonary hypertension is a significant predictor of mortality and morbidity among CKD patients. Prevalence of pulmonary hypertension in CKD varies from 15-60% depending on the study population and method of measuring pulmonary artery systolic pressure (PASP). 2D echocardiographic estimation of PASP is one of the non-invasive method of diagnosing pulmonary hypertension. Present study was aimed to know the prevalence and predictors of pulmonary hypertension in CKD 3b-5ND (non dialysis) patients.

Prevalence of pulmonary hypertension in COPD patients living at high altitude

BackgroundPulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). ObjectivesTo assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). MethodsCross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). ResultsWe included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. ConclusionsThe estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.

Bronchiectasis: Retrospective Analysis of Clinical and Pathological Findings in a Tertiary-Care Hospital.

Background Bronchiectasis is still a challenging chronic lung disease in developing countries. Patients with bronchiectasis can also have pulmonary hypertension. There are sparse data on the prevalence of pulmonary hypertension in patients with bronchiectasis. Materials and methods. Archived H&E-stained slides of 141 patients histopathologically diagnosed with bronchiectasis were reevaluated. Cases were categorized into 4 subgroups based on histology: tubular, varicose, follicular, and cystic. In addition, concomitant histopathological changes were also reevaluated. For patients with available CT sections, main, right, and left pulmonary artery (PA) diameters and PA/aorta ratio were measured with regard to pulmonary hypertension. Results Of the cases, 70% (n = 89) were female and 30% (n = 52) were male, with a mean age of 36.58 in females and 33.84 in males. Histopathologically, 43% (n = 68) of the cases showed follicular, 37% (n = 59) showed varicose, 35% (n = 56) showed tubular, and 28% (n = 45) showed cystic bronchiectasis morphology. All cases showed chronic inflammation, fibrosis, muscle destruction, and cartilage destruction. Aspergillus were present in 11% of the cases showing cystic morphology. Approximately 17% of the cases (n = 24) were found to have neuroendocrine cell proliferations. In cases with medial hypertrophy, a statistically significant increase in the left pulmonary artery diameter was radiologically determined. Conclusions Medial hypertrophy was found to be significant with regard to indicating a radiological increase in left pulmonary artery diameter. Vascular changes observed in bronchiectasis cases and the presence of neuroendocrine cell proliferations should be specified in pathology reports, and aspergilloma should be carefully investigated in cases with predominant cystic morphology.

The Effects of Healthy Aging on Right Ventricular Structure and Biomechanical Properties: A Pilot Study.

Healthy aging has been associated with alterations in pulmonary vascular and right ventricular (RV) hemodynamics, potentially leading to RV remodeling. Despite the current evidence suggesting an association between aging and alterations in RV function and higher prevalence of pulmonary hypertension in the elderly, limited data exist on age-related differences in RV structure and biomechanics. In this work, we report our preliminary findings on the effects of healthy aging on RV structure, function, and biomechanical properties. Hemodynamic measurements, biaxial mechanical testing, constitutive modeling, and quantitative transmural histological analysis were employed to study two groups of male Sprague-Dawley rats: control (11 weeks) and aging (80 weeks). Aging was associated with increases in RV peak pressures (+17%, p = 0.017), RV contractility (+52%, p = 0.004), and RV wall thickness (+38%, p = 0.001). Longitudinal realignment of RV collagen (16.4°, p = 0.013) and myofibers (14.6°, p = 0.017) were observed with aging, accompanied by transmural cardiomyocyte loss and fibrosis. Aging led to increased RV myofiber stiffness (+141%, p = 0.003), in addition to a bimodal alteration in the biaxial biomechanical properties of the RV free wall, resulting in increased tissue-level stiffness in the low-strain region, while progressing into decreased stiffness at higher strains. Our results demonstrate that healthy aging may modulate RV remodeling via increased peak pressures, cardiomyocyte loss, fibrosis, fiber reorientation, and altered mechanical properties in male Sprague-Dawley rats. Similarities were observed between aging-induced remodeling patterns and those of RV remodeling in pressure overload. These findings may help our understanding of age-related changes in the cardiovascular fitness and response to disease.

Interplay Between Thyroid Hormone Status and Pulmonary Hypertension in Graves' Disease: Relevance of the Assessment in Thyrotoxic and Euthyroid Patients.

BackgroundGraves’ disease (GD) is the most common cause of hyperthyroidism and can cause cardiac changes, such as pulmonary hypertension.MethodsThis is a prospective study in which we obtained demographic, clinical, laboratory data and characteristics of the GD, in addition to investigating cardiorespiratory function, focusing on the detection of pulmonary hypertension. Patients were separated into two groups: thyrotoxicosis and euthyroidism. Ninety patients with GD of both sexes, over 18 years of age, were included. The cardiorespiratory assessment included an echocardiographic evaluation, a questionnaire of specific symptoms, spirometry and a six-minute walk test.ResultsThe hyperthyroid group included 42 patients (47.73%) and the euthyroid group 46 patients (52.27%); 78 were women (86.67%). The prevalence of pulmonary hypertension between the hyperthyroidism (48.57%) and the euthyroidism (29.41%) groups was not different. Free thyroxine levels (FT4) (OR 1.266), higher left atrium volume (OR 1.113) and right ventricle diameter were associated with pulmonary hypertension. A direct correlation between FT4 with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as also an inverse correlation between initial oxygen saturation (SpO2) with diagnostic time and drop SpO2 with the ratio between the diastolic velocity E of the mitral flow and the diastolic velocity of the mitral ring (E/e’) were observed in the euthyroid group. An inverse correlation between FT4 levels with walked distance as % of predicted value, and a direct correlation between E/e’ ratio and walked distance as % of predicted value were observed in the hyperthyroid group.ConclusionWe emphasize the importance of a cardiorespiratory reassessment in GD, even after a long-term control of the thyrotoxic state, as we demonstrate that about 30% of these patients remain with PH and are subject to specific treatment.

Prevalence of pulmonary hypertension in OSA patients with obstructive airway diseases

Objectives: The aim of this study is to study the prevalence of pulmonary hypertension in obstructive sleep apnea patients with obstructive airway disease using ECHO. Subjects and method: The study was performed on 50 obstructive airway diseases (OAD) patients out of which 35 were associated with OSA. After getting informed consent, patients basic demographic details, clinical history, detailed general and systemic examination, spirometry, sleep study, Echo were performed for each patients. Results: In our study pulmonary hypertension were higher in number in OSA patients compared to the NON-OSA patients. Among the obese patients higher number of pulmonary hypertension were observed. As far as severity is concerned more number of severe pulomonary hypertension were noted in OSA and Obese patients. Conclusion: Pulmonary hypertension is invariably present in most of the OSA patients with obstructive airway diseases. Hence control of OSA by CPAP therapy in OAD patients will prevent or delay the development of pulmonary hypertension.

Pulmonary hypertension among patients hospitalized with acute heart failure in Buea, South West Region of Cameroon.

pulmonary hypertension (PH) is a common and severe complication in patients with heart failure (HF). It is associated with increased morbidity and mortality. There is limited data in Cameroon on the prevalence of PH in hospitalized HF patients and its impact on outcome. we analyzed data from consecutive adult patients hospitalized with. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure (PASP) ≥ 35mmHg. eighty-six (86) consecutive patients were hospitalized and 66(76.7%) had measurable PASP on echocardiography. Of those with echocardiographically measurable PASP (66), there were 39 (59.1%) females. The median (IQR) age was 60 (42-76) years. The prevalence of PH was 93.9%. PH was present in all (100%) patients with right heart failure (RHF) and in 62 (93.9%) patients with left heart failure (LHF). Severe PH (PASP ≥55 mmHg) was seen in 45 (68.2%, [95% CI: 55.6-75.1]) patients. The mean PASP was significantly higher in those with isolated RHF compared with those who had isolated left or bi-ventricular failure. Factors likely associated with moderate-to-severe PH (PASP ≥ 45 mmHg) were female sex, RHF, and right atrial dilatation. After adjusting for sex, right atrial dilation was independently associated with moderate-to-severe PH. In-hospital death occurred in 7 (10.6%, [95% CI: 4.4-20.6]) patients. The median (IQR) time to death was 6 (3-7) days and ranged from 2 to 8 days. All deaths (100%) occurred in those with moderate-to-severe PH. the prevalence of pulmonary hypertension in hospitalized heart failure patients was high with two third of the patients having severe PH, and most commonly occurred in females. All deaths occurred in patients with moderate-to-severe PH.

Pulmonary Hypertension in People with Sickle Cell Disease in a Nigerian tertiary Hospital

Objectives: The aim of this article is to estimate the prevalence of pulmonary hypertension (PHTN) among patients with sickle cell disease (SCD) and to determine the associated factors. Materials and Methods: It was a hospital-based cross-sectional study involving 113 SCD participants in their steady state. Transthoracic echocardiography was done in accordance with the American Society of Echocardiography (ASE) guidelines to determine the peak tricuspid regurgitant velocity (TRVmax); complete blood count, oxygen saturation, serum creatinine, and urea were also done for all the participants. Results: The participants had a mean age of 18.1 ± 9.85 years, and 64 (56.6%) of them were males. Seven (6.2%) of the participants had PHTN as determined by a TRVmax of ≥2.5 m/s. PHTN was significantly associated with age, sex, body mass index (BMI), blood pressure, oxygen saturation, and serum creatinine. Conclusion: PHTN remains common among patients with SCD and it is associated with female gender, increasing age, a rising BMI, blood pressure and serum creatinine, and a decreasing oxygen saturation and hematocrit. We recommend regular screening of patients with SCD for PHTN and that these associated factors should be taken into consideration when screening SCD patients for PHTN.

Spectrum of interstitial lung diseases and their association with pulmonary hypertension.

Interstitial lung diseases (ILDs) are an intriguing group of pulmonary disorders, which still require the study of epidemiological, genetic, pathophysiological, clinical, and radiological parameters. Pulmonary hypertension (PH) is an underreported complication in interstitial lung diseases which is associated with worse outcome. In our study, we have reported the spectrum of ILDs and estimated the prevalence of pulmonary hypertension among these subjects at a tertiary care centre. A cross-sectional study was performed in which demographical, clinical, radiological, and histological data of subjects with ILD, attending the department of Respiratory Medicine in the University was collected from 1st September 2018 to 31st August 2019. Serological tests were done wherever indicated. Standard criteria along with multidisciplinary opinion were needed to arrive at the final diagnosis. All subjects were screened for pulmonary hypertension via 2-D echocardiography. Mean pulmonary artery pressure ≥20 mmHg was used to define PH. In the defined period, 239 subjects were enrolled (58% females, n=141; mean age 52.38±13.40 years). A tissue diagnosis was obtained in 34% cases. The most common ILD was hypersensitivity pneumonitis (32.2%), followed by autoimmune-ILD (31.4%), idiopathic pulmonary fibrosis (IPF) (15.9%) and sarcoidosis (12.6%), non-IPF idiopathic interstitial pneumonitis (2.1%) and rest 21 (5.9%) subjects were diagnosed as other types of ILD. Pulmonary hypertension was seen in 46.0% of subjects.

Increased myocardial oxygen consumption rates are associated with maladaptive right ventricular remodeling and decreased event-free survival in heart failure patients

BackgroundReduced left ventricular (LV) function is associated with increased myocardial oxygen consumption rate (MVO2) and altered sympathetic activity, the role of which is not well described in right ventricular (RV) dysfunction. Methods and results33 patients with left heart failure were assessed for RV function/size using echocardiography. Positron emission tomography (PET) was used to measure 11C-acetate clearance rate (kmono), 11C-hydroxyephedrine (11C-HED) standardized uptake value (SUV), and retention rate. RV MVO2 was estimated from kmono. 11C-HED SUV and retention indicated sympathetic neuronal function. A composite clinical endpoint was defined as unplanned cardiac hospitalization within 5 years. Patients with (n = 10) or without (n = 23) RV dysfunction were comparable in terms of sex (male: 70.0 vs 69.5%), LV ejection fraction (39.6 ± 9.0 vs 38.6 ± 9.4%), and systemic hypertension (70.0 vs 78.3%). RV dysfunction patients were older (70.9 ± 13.5 vs 59.4 ± 11.5 years; P = .03) and had a higher prevalence of pulmonary hypertension (60.0% vs 13.0%; P = .01). RV dysfunction was associated with increased RV MVO2 (.106 ± .042 vs .068 ± .031 mL/min/g; P = .02) and decreased 11C-HED SUV and retention (6.05 ± .53 vs 7.40 ± 1.39 g/mL (P < .001) and .08 ± .02 vs .11 ± .03 mL/min/g (P < .001), respectively). Patients with an RV MVO2 above the median had a shorter event-free survival (hazard ratio = 5.47; P = .01). Patients who died within the 5-year follow-up period showed a trend (not statistically significant) for higher RV MVO2 (.120 ± .026 vs .074 ± .038 mL/min/g; P = .05). ConclusionsRV dysfunction is associated with increased oxygen consumption (also characterized by a higher risk for cardiac events) and impaired RV sympathetic function.

Estimates of Prevalence of Pulmonary Hypertension according to Different International Definitions.

Background Pulmonary hypertension is a dreaded disease associated with considerable morbidity and mortality. The pulmonary hypertension developing due to chronic respiratory disease is a unique subset with symptoms often getting masqueraded by the underlying respiratory condition. The importance of early detection of this complication has been realized worldwide, and recently, the definition of pulmonary hypertension was revised to set the cutoff of mean pulmonary artery pressure (mPAP) at 20 mmHg instead of 25 mmHg at rest. In our study, we have tried to estimate the difference this new definition brings to the prevalence of pulmonary hypertension among interstitial lung disease patients at our centre. Methods This was a cross-sectional study in which all the patients of ILDs (n = 239) attending the outdoor and indoor Department of Respiratory Medicine, King George's Medical University, India, for the duration of one year were subjected to transthoracic echocardiography along with measurement of serum pro-B-type natriuretic peptide (BNP) and troponin T values. The data were analyzed using the different definitions, and the prevalence was compared. Result Incidence of pulmonary hypertension among ILD patients at mPAP cutoff ≥ 25 was 28.9%, while that at value ≥20 mmHg, incidence of pulmonary hypertension increased to 46.0%. An increment of 15–20% in incidence of pulmonary hypertension was observed among different types of ILD when cutoff of mPAP was changed. Conclusion The new definition helps in a significant increase in the detection of pulmonary hypertension, which certainly helps in earlier detection and better management of patients.

Prevalence of pulmonary hypertension among children with Down syndrome: A systematic review and meta-analysis

BACKGROUNDPulmonary hypertension (PH) has serious short- and long-term consequences. PH is gaining increasing importance in high risk groups such as Down syndrome (DS) as it influences their overall survival and prognosis. Hence, there is a dire need to collate the prevalence rates of PH in order to undertake definitive measures for early diagnosis and management. AIMTo determine the prevalence of PH in children with DS.METHODSThe authors individually conducted a search of electronic databases manually (Cochrane library, PubMed, EMBASE, Scopus, Web of Science). Data extraction and quality control were independently performed by two reviewers and a third reviewer resolved any conflicts of opinion. The words used in the literature search were “pulmonary hypertension” and “pulmonary arterial hypertension”; “Down syndrome” and “trisomy 21” and “prevalence”. The data were analyzed by Comprehensive Meta-Analysis Software Version 2. Risk of bias assessment and STROBE checklist were used for quality assessment.RESULTSOf 1578 articles identified, 17 were selected for final analysis. The pooled prevalence of PH in these studies was 25.5%. Subgroup analysis was carried out for age, gender, region, year of publication, risk of bias and etiology of PH.CONCLUSIONThis review highlights the increasing prevalence of PH in children with DS. It is crucial for pediatricians to be aware of this morbid disease and channel their efforts towards earlier diagnosis and successful management. Community-based studies with a larger sample size of children with DS should be carried out to better characterize the epidemiology and underlying etiology of PH in DS.

Racial disparities in renal outcomes of pulmonary hypertension hospitalizations: analysis of 2016 to 2018 National Inpatient Sample

Abstract Background Although the prevalence of pulmonary hypertension among black and white individuals are similar, black individuals have been reported to have worse prognosis. However, data on renal outcomes and racial disparities in pulmonary hypertension patients are extremely limited. Purpose To investigate the racial differences in acute renal failure outcome of pulmonary hypertension hospitalizations. Methods We queried 2016–2018 National Inpatient Sample (NIS) database to identify pulmonary hypertension patients using appropriate ICD-10 codes. Race variable in the database was used to categorize pulmonary hypertension patients into Blacks and Others groups (Whites, Hispanics, Asian or Pacific Islanders). We used Chi-square test to evaluate the difference between binary variable, and Student's t- test for differences between continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient level confounders. Results Among the total 1,362,765 pulmonary hypertension patients across three years, 68% (906,994) were Whites, 18.9% (251,530) were Blacks, 7.8% (104,169) Hispanics and 2% (30,139) Asian or Pacific Islanders. Blacks with pulmonary hypertension were younger (mean age, 64.1 vs. 73.1 years; p&amp;lt;0.01), more females (57.4% vs. 42.5%; p&amp;lt;0.01), higher prevalence of diabetes (47.2% vs. 39.9%; p&amp;lt;0.01), systolic heart failure (31.2% vs. 25.1%; p&amp;lt;0.01), chronic kidney disease (43.2% vs. 36.4%; p&amp;lt;0.01), end-stage renal disease (17.1% vs. 6.8%; p&amp;lt;0.01), obesity, obstructive sleep apnea and anemia compared to Other races. After adjusting for hospital and patient level confounders including above mentioned comorbidities, Blacks had higher odds of acute renal failure compared to Others [Adjusted Odds ratio: 1.15 (1.11 – 1.18); p&amp;lt;0.01]. Blacks with pulmonary hypertension were also associated with unadjusted longer length of stay (7.0 vs. 6.4 days; p&amp;lt;0.01) and similar total hospitalization charges (USD: $78,408 vs. $80,076; p=0.18) compared to Others. Conclusions Racial minorities are underrepresented among patients with pulmonary hypertension. Blacks with pulmonary hypertension have higher co-morbidity and are associated with worse in-hospital renal outcomes compared to other races. They are also associated with longer length of stay. Vigilant renal functions monitoring, and early nephrologists involvement are needed during hospitalization to prevent worse renal outcomes in this patient population. Funding Acknowledgement Type of funding sources: None.