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Prevalence, clinical characteristics and outcome of pulmonary hypertension among admitted heart failure patients.
Ann Afr Med. 2013 Oct-Dec;12(4):197-204
Authors: Karaye KM, Saidu H, Bala MS, Yahaya IA
Abstract
BACKGROUND: There is paucity of data in Africa on the prevalence of pulmonary hypertension (PHT) and its impact on morbidity and short-term mortality in heart failure (HF) patients. The aim of this study was to assess the prevalence of PHT, its clinical characteristics and in-hospital mortality among HF patients admitted to a referral hospital in Nigeria.
METHODS: The study was carried out on serially-admitted HF patients who satisfied the inclusion criteria, in a Nigerian tertiary health center. PHT was defined as the presence of mean pulmonary artery pressure (mPAP) of ≥25 mmHg, assessed using Doppler echocardiography and Chemla formula.
RESULTS: A total of 80 admitted HF patients were studied serially. 53 of them (66.25%) had PHT while the remaining 27 (33.75%) had normal mPAP. mPAP was 38.31 ± 12.23 mmHg and 16.39 ± 5.48 mmHg (P < 0.001) for subjects with and without PHT, respectively. The most common cause of HF was hypertensive heart disease (HHD) (28 patients; 35%). Subjects with PHT had relatively lower systolic blood pressure (SBP) (P = 0.044), and larger left atrium (P = 0.036) and left ventricle (LV) at both end-diastole and end-systole (P = 0.036 and P = 0.008, respectively), and a trend toward lower LV ejection fraction (LVEF) (P = 0.053). There was no relationship between mPAP and N-terminal pro-B type natriuretic peptide (P > 0.05). A total of 12 HF patients (15.0%) died, out of whom 8 (66.7%) had PHT. Cardiogenic shock (P = 0.044) and trans-mitral flow velocities ratio (P = 0.023) were the independent determinants of in-hospital mortality.
CONCLUSION: PHT was common among the admitted HF patients, and was associated with worse morbidity indices, and a trend toward higher mortality. We recommend that HF patients be screened for PHT, and its presence should be taken into consideration in the management and prognostication of affected patients.
PMID: 24309407 [PubMed - indexed for MEDLINE]