Journal of the American Heart Association · 2022
Clinical Characteristics of Patients Undergoing Right Heart Catheterizations in Community Hospitals.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Jansen Samara M A, Huis In 't Veld Anna E, Tolen Peter Hans C G, Jacobs Wouter, Willemsen H M, Grotjohan Hans P, Waskowsky Marc, van der Maten Jan, van der Weerdt Arno, Hoekstra Romke, Pérez Matos Ana J, Overbeek Maria J, Mollema Sjoerd A, El Bouazzaoui Lahssan H Hassan, Vriend Joris W J, Roorda J Milena M, de Nooijer Ramon, van der Lee Ivo, Voogel A J, Post Johannes C, Macken Thomas, Aerts Jacqueline M, van de Ven Marjo J T, Bergman Heidi, Bakker-de Boo Mirjam, de Boer Roline C, Vonk Noordegraaf Anton, de Man Frances S, Bogaard Harm Jan
Аннотация
Background Recognition of precapillary pulmonary hypertension (PH) has significant implications for patient management. However, the low a priori chance to find this rare condition in community hospitals may create a barrier against performing a right heart catheterization (RHC). This could result in misclassification of PH and delayed diagnosis/treatment of precapillary PH. Therefore, we investigated patient characteristics and echocardiographic parameters associated with the decision whether to perform an RHC in patients with incident PH in 12 Dutch community hospitals. Methods and Results In total, 275 patients were included from the OPTICS (Optimizing PH Diagnostic Network in Community Hospitals) registry, a prospective cohort study with patients with incident PH; 157 patients were diagnosed with RHC (34 chronic thromboembolic PH, 38 pulmonary arterial hypertension, 81 postcapillary PH, 4 miscellaneous PH), while 118 patients were labeled as probable postcapillary PH without hemodynamic confirmation. Multivariable analysis showed that older age (>60 years), left ventricular diastolic dysfunction grade 2-3, left atrial dilatation were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension-associated conditions, right atrial dilatation, and tricuspid regurgitation velocity ≥3.7 m/s favor an RHC performance. Conclusions Older age and echocardiographic parameters of left heart disease were independently associated with the decision to not perform an RHC, while presence of prior venous thromboembolic events or pulmonary arterial hypertension-associated conditions, right atrial dilation, and severe PH on echocardiography favored an RHC performance. As such, especially elderly patients may be at an increased risk of diagnostic delays and missed diagnoses of treatable precapillary PH, which could lead to a worse prognosis.