Conference: 2012 International PHA Conference and Scientific Sessions
Release Date: 06.22.2012
Presentation Type: Abstracts
Kathryn Stackhouse, Ajinkya Rane, Stephen Hart, Ganesh Devendra, Wael Elmallah, Richard A. Krasuski
Cleveland Clinic Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH
BACKGROUND: Diabetes (DM) complicates management in a number of disease states and impacts survival. With insulin resistance demonstrated in pulmonary hypertension (PH), we sought to examine the impact of DM.
METHODS: Demographics, echo data and invasive hemodynamics were prospectively collected in 261 patients with PH referred for initial hemodynamic assessment. DM was defined as documented insulin resistance or treatment with antidiabetic medications.
RESULTS: 55 patients (21%) had DM; and compared to nondiabetics were older (61±13 vs. 56 ±13 yrs, p=0.02), more likely black (29% vs. 14%, p=0.02), hypertensive (71% vs. 30%, p<0.001) and with higher creatinine (1.1±0.5 vs. 1.0±0.4 mg/dl, p=0.03). They had similar function class but more commonly had pulmonary venous causes (24% vs. 10%, p=0.01). Echo findings including biventricular function, tricuspid regurgitation and pressure estimates were similar. Invasive pulmonary pressure and cardiac output were similar, but right atrial pressure was higher (14±8 vs. 10±5 mm Hg, p<0.001). Despite similar treatment, survival was markedly worse and remained so after statistical adjustment (Figure 1).
CONCLUSION: Diabetics referred for assessment of PH more likely have pulmonary venous disease, with hemodynamics suggestive of more right-sided diastolic dysfunction. Survival in these patients is markedly worsened and merits further study.