Unrecognized pulmonary arterial hypertension in hospitalized patients
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ORIGINAL PAPER
Unrecognized pulmonary arterial hypertension in hospitalized patients Andres Mora Carpio1 · Aaron Goertz1 · Colleen Kelly2 · Leslee Willes2 · Stuart F. Quan3,4 · Gregg S. Pressman1 · Abesh Niroula5 · Sunil Sharma6 Received: 30 June 2020 / Accepted: 12 November 2020 © Springer Nature B.V. 2020
Abstract Pulmonary hypertension (PH) is an underdiagnosed and potentially fatal condition. The utility of screening for PH in hospitalized patients undergoing echocardiography is unknown. The goal of this study was to determine the prevalence of undiagnosed pulmonary hypertension (PH) and probable pulmonary arterial hypertension (PAH) in hospitalized patients undergoing echocardiography for any indication. All hospitalized patients undergoing echocardiography were identified and echocardiographs reviewed prospectively for the presence of a tricuspid regurgitant (TR) jet. Electronic medical records (EMR) of patients with a TR jet ≥ 3 m/s were reviewed for identifiable causes of pulmonary hypertension. Patients with no identifiable cause were classified as presumptive World Health Organization (WHO) Group 1 PH (also known as PAH). These PAH patients were compared to other PH patients for baseline demographic characteristics and comorbidities as well as 30-day readmission and mortality. The admitting physicians of patients classified as PH were advised to consider further evaluation including right heart catheterization. We reviewed 4417 consecutive echocardiograms and identified 448 with a TR jet ≥ 3 m/s. Of these 448 patients with PH, 47 were identified as “presumptive PAH” and the other 401 as having PH belonging to WHO Groups 2–5. Presumptive PAH represented 1% of screened echocardiograms and 10.5% of those identified to have an elevated TR jet. Of the patients identified as presumptive PAH, 8 underwent further evaluation including a right heart catheterization, where 5 were confirmed to have PAH. Kaplan–Meier analysis revealed 30-day readmission was higher among those classified as PAH. Our data shows that pulmonary hypertension, as defined by TR jet ≥ 3 m/s, is frequently encountered in hospitalized patients undergoing echocardiography for any reason. A careful review of echocardiogram findings and clinical history suggested 10.5% of those with PH (and 1% of all screened patients) may meet the criteria for PAH. Considering PH is a fatal condition which is frequently missed, a hospital screening program seems feasible. Keywords Pulmonary hypertension · Echocardiography · Hospitalized patients
Introduction * Sunil Sharma [email protected] 1
Einstein Medical Center, Philadelphia, PA, USA
2
Willes Consulting Group, Inc, Encinitas, CA, USA
3
Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
4
Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ, USA
5
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University Hospital, Atlanta, GA, USA
6
Division of Pulmonary, Criti
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