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Trends in Right Heart Catheterizations in a Small Community Hospital

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.21.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Vikas Batra 

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Pulmonary Arterial Hypertension (PAH) is a progressive and fatal disease. The early symptoms of PAH, such as dyspnea, fatigue and dizziness, are non specific and often mild. Although several tests such as an echocardiogram may suggest a diagnosis of pulmonary hypertension, a right heart catheterization (RHC) is the only way of accurately measuring the pulmonary artery pressures and making a diagnosis of pulmonary arterial hypertension. The REVEAL registry showed that the mean duration between symptom onset and diagnostic RHC was 2.8 years. This means that PAH is frequently not diagnosed until the disease is relatively advanced. We looked at the trends in RHC in a small community hospital after establishment of the interventional cardiology program.

Background:  Pulmonary Arterial Hypertension (PAH) is a progressive and fatal disease. The early symptoms of PAH, such as dyspnea, fatigue and dizziness, are non specific and often mild. Although several tests such as an echocardiogram may suggest a diagnosis of pulmonary hypertension, a right heart catheterization (RHC) is the only way of accurately measuring the pulmonary artery pressures and making a diagnosis of pulmonary arterial hypertension. The REVEAL registry showed that the mean duration between symptom onset and diagnostic RHC was 2.8 years. This means that PAH is frequently not diagnosed until the disease is relatively advanced. We looked at the trends in RHC in a small community hospital after establishment of the interventional cardiology program. 

Methods: We looked at the total number of diagnostic cardiac catheterizations from 2010 until 2013. Catheterizations were categorized as left heart catheterization (LHC), left and right heart catheterization (LRHC) and right heart catheterization (RHC). We specifically looked at right ventricular systolic pressure (RVSP) on echocardiogram and hemodynamic data in patients who underwent LRHC and RHC.

Results: Total number of  diagnostic catheterizations increased from 1,188 in 2010 to 1,349 in 2013. There was no significant change in number of LHC and RHC over this time. However total number of LRHC increased from 190 in 2010 (16% of total catheterizations) to 344 (25.5%) in 2013. Total number of RHC performed each year were very few. Range was 12 in 2010 (1.01% of total catheterizations) to 28 in 2012 (2.15%). There was no significant difference in average age and gender distribution between LHC, LRHC and RHC. 

In patients undergoing RHC, average systolic PAP was 56.17+19.32 mmHg, mean Pulmonary arterial pressure (PAP) was 35.25+11.13 mmHg, and pulmonary capillary wedge pressure (PCWP) was 13.67+6.49 mmHg. Most of the RHC were done for abnormal echocardiogram which showed average RVSP of 66.43+20.91 mmHg. In contrast patients undergoing LRHC, systolic PAP was 40.65+13.85 mmHg  mean PAP was 26.75+9.08 mmHg, and PCWP 15.43+6.93 mmHg. Most of the LRHC were done for evaluation of dyspnea and RVSP on echo was 41.26+10.81 mmHg. 

Conclusions: There is increase in use of left and right heart catheterization for evaluation of dyspnea. Total number of diagnostic right heart catheterization still remain very low. In a community hospital, pulmonary arterial hypertension is diagnosed late as evidenced by median systolic PAP of 62 and mean PAP of 39.5mmHg at the time of diagnosis. 

Type: Clinical science