Pourpose: Determine the prevalence and clinical characteristics of adverse prognostic factors in a population with recent diagnosis of PH.
Methods: Patients with recent diagnosis of PH (< 7 days) confirmed by right heart catheterization, with a mean pulmonary-artery pressure (MPAP) = 25 mm Hg (using a Swan Ganz Catheter) from three heart failure and pulmonary hypertension services were analyzed between March 2012 and December 2016. According to the recommendations of international guides, the following data were recorded: Personal data, PH group (G), clinical features: symptoms, functional class FC. Direct hemodynamic parameters: pulmonary pressures (PP), wedge pressure (WP), right atrium pressure (RA) and cardiac index (CI). Functional: 6 minute walk (6MW) test distance. Echocardiographic variables: right ventricle systolic function (RVSF), tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary pressure and presence of pericardial effusion (PE). Data obtained were analyzed with BioEstat 5.3 program. Adverse prognosis factors identified were: history of heart failure (HF), syncope, advance functional class (III-IV), performance in the 6MW test < 350 m, presence of PE, TAPSE =15¸ RA = 12 e CI = 2,2.
Results: Multicenter, observational, descriptive, consecutive and prospective study. 107 patients where included. 74% women. Mean age was 58,8 (±19) years, 33% = 70. The mean delay in diagnosis was 24 months after the first sign or symptom recorded. PH group distribution: GI 63%, GII15%, GIII9%, GIV6% and GV6%. FC of presentation: I4%, II 40%, III34% and IV20%. History of HF in 72%, syncope in 23%. 6MW mean distance walked was 320 (±148) meters, 47 % performed = 350 meters. RHC: MPAP 48.3 (±16) mmHg, RAP 9.7 mmHG (±5,2) and = 15 mmHg 27%; CI 2,78 litres/min/mt2 (= 2,2 23%). Ecocardiographic data show: 79% impaired FSVD (42% slight, 18% moderate and 19% severe). Mean TAPSE 17.8 (±4) mm, = 15 mm 37 % and PE in 25%.
Conclusions: In our population with confirmed pulmonary hypertension, with a predominance of group I, we had a high presentation in over 70 years of age. At diagnosis time a high number of patients present adverse prognosis factors. This findings remark the need to use early diagnosis and therapeutic strategies.