Clinical study of patients with primary pulmonary hypertension (PPH)

Abstract

Background: Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition
defined as an increase in mean pulmonary arterial pressure (PAP) ≥25 mmHg at rest as assessed by
right heart catheterization (RHC). Although there is some underestimation and overestimation of PAP
between transthoracic Doppler echo (DE) and RHC, Doppler echo remains an indispensable screening
tool for the assessment of PH.
Objective: clinical evaluation of patients with primary pulmonary hypertension (PPH) and assess
vasoreactivity testing to identify patients who may benefit from long term therapy with calcium channel
blockers (CCBs).
Patients and methods: This prospective study was performed in the cardiac catheterization division in
Al-Zahraa teaching hospital in Al-Kut. We studied the prevalence of certain variables among forty two
patients with PPH from "March 2014 to Nov 2016" including the clinical triggers, electrocardiographic
(ECG) changes, Echocardiographic variables , RHC and vasoreactivity test with intravenous adenosine
to identify acute positive responders and long term responders to CCB.
Results: A total of forty two patients, female to male ratio were 2.8:1 with a mean age of 38±10(years).
Dyspnea is a common clinical trigger (85%). Abnormal ECG was found in (90.5%) of patients, the
majority had right ventricular hypertrophy (RVH) (76.2%). Echocardiographically all patients had
RVH. There was some differences in mean PAP (36±4.9mmhg) derived by DE from that obtained by
RHC (47±4.78mmhg). RHC reveal that 6 patients (15.78%) were acute positive responders to
intravenous adenosine and about 4 patients (66%) were long term responders to CCB during 3months
follow up echocardiography.
Conclusions: There is some discrepancy in the mean PAP between Doppler echo and RHC within ±10
mm Hg for pulmonary artery pressure estimates. 15.7% of patients at RHC were acute positive
responder to intravenous adenosine and half of them were long term responder to CCB.