The Clinical Profile and Under-Diagnosis of Pulmonary Hypertension in U.S. Veteran Patients

Study Questions:

What are the prevalence, clinical profile, and diagnostic strategies used for pulmonary hypertension (PH) in the US veteran population?


The echocardiography registries from two major Veterans Affairs hospitals were accessed to identify patients with at least moderate PH, defined here as a pulmonary artery systolic pressure (PASP) ≥60 mm Hg detected echocardiographically.


From a total of 10,471 individual patient transthoracic echocardiograms, the authors identified moderate or severe PH in 340 patients (332 men, mean 77 years old, mean PASP 69.4 ± 10.5 mm Hg), of which PH was listed as a diagnosis in the medical record for only 59 (17.3%). At a mean of 832 days (0-4817 days) following echocardiography diagnosing PH, 150 (44.1%) patients were deceased. PH was present without substantial left heart remodeling: the mean left ventricular (LV) ejection fraction was 0.50 ± 0.16, LV end-diastolic dimension was 4.9 ± 1.0 cm, and left atrial dimension was 4.4 ± 0.7 cm. Cardiac catheterization (n = 122, 36%) demonstrated a mean pulmonary artery pressure of 40.5 ± 11.4 mm Hg, pulmonary capillary wedge pressure of 22.6 ± 8.9 mm Hg, and pulmonary vascular resistance of 4.6 ± 2.9 Wood units. Diagnostic strategies for PH were variable and often incomplete; for example, only 16% of appropriate patients were assessed with a nuclear ventilation/perfusion (V/Q) scan for thromboembolic causes of PH.


The authors concluded that PH is underdiagnosed and associated with substantial mortality in the veteran population.


This study reported that the prevalence of PH in an unselected cohort of veteran patients is ~14%, which is similar to rates of PH reported previously for populations characterized by a high burden of comorbid diseases known to promote pulmonary vascular dysfunction. These data suggest that despite the well-established relationship between PH and cardiovascular morbidity and mortality, this disease remains substantially under-recognized in clinical practice. Overall, the data highlight the need for enhanced awareness among the practicing cardiovascular community regarding contemporary strategies for identifying treatable forms of PH, particularly chronic thromboembolic PH, or assessing PH severity.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Echocardiography/Ultrasound, Hypertension

Keywords: Pulmonary Wedge Pressure, Cardiac Catheterization, Blood Pressure, Pulmonary Artery, United States Department of Veterans Affairs, Prevalence, Cardiology, Hydrogen-Ion Concentration, Vascular Resistance, Ventricular Function, United States, Hypertension, Echocardiography

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