Purpose: 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 2018. According to the recommendations of international guidelines, 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), systolic pulmonary pressure and presence of pericardial effusion (PE). Data obtained weas analyzed with STATA 14 program. Adverse prognosis factors identified were: history of heart failure (HF), syncope, advance functional class (III-IV), performance in the 6MW test < 440 m, presence of PE, RA = 14 mm Hg e CI = 2,2 litres/min/mt2
Results: Multicenter, observational, descriptive, consecutive and prospective study. 148 patients were included, from which 75% were women. Mean age was 57.8 (±19) years, 27% = 70. The mean delay in diagnosis was 23 months after the first sign or symptom recorded. PH group distribution: GI 68%, GII 13%, GIII 7%, GIV 6% and GV 6%. FC of presentation: I 4%, II 39%, III 36% and IV 21%. History of HF in 79%, syncope in 24%. 6MW mean walked distance was 317 (±144) meters, 74% performed = 440 meters. RHC: MPAP 48 (±16) mm Hg, RAP 9 mm HG (±5) and = 14 mm Hg 19 %; CI 2,8 litres/min/mt2 (= 2,2 22%). Ecocardiographic data showed: 80 % impaired FSVD (40% slight, 19% moderate and 21% severe) and PE in 25%.
Conclusions: In our population with confirmed pulmonary hypertension, with a group I predominance, we had a high prevalence of presentation in patients over 70 years of age. At diagnosis time a high number of patients presented adverse prognosis factors. These findings remark the need of using early diagnosis and therapeutic strategies.