TY - JOUR
T1 - Clinical Characteristics of Patients Undergoing Right Heart Catheterizations in Community Hospitals
AU - Jansen, Samara M.A.
AU - In ’T Veld, Anna E.Huis
AU - Tolen, Peter Hans C.G.
AU - Jacobs, Wouter
AU - Willemsen, H. M.
AU - Grotjohan, Hans P.
AU - Waskowsky, Marc
AU - van der Maten, Jan
AU - van der Weerdt, Arno
AU - Hoekstra, Romke
AU - Matos, Ana J.Pérez
AU - Overbeek, Maria J.
AU - Mollema, Sjoerd A.
AU - El Bouazzaoui, Lahssan H.Hassan
AU - Vriend, Joris W.J.
AU - Roorda, J. Milena M.
AU - de Nooijer, Ramon
AU - van der Lee, Ivo
AU - Voogel, A. J.
AU - Post, Johannes C.
AU - Macken, Thomas
AU - Aerts, Jacqueline M.
AU - van de Ven, Marjo J.T.
AU - Bergman, Heidi
AU - Bakker-De Boo, Mirjam
AU - de Boer, Roline C.
AU - Noordegraaf, Anton Vonk
AU - de Man, Frances S.
AU - Bogaard, Harm Jan
N1 - Funding Information: This work was supported by the Netherlands Cardiovascular Research Initiative: An initiative with the support of the Dutch Heart Foundation (CVON2018-29 PHAEDRA-IMPACT). Funding Information: H.J.B. and A.V.N. received unrestricted research support for the OPTICS registry from Actelion, Merck Sharp & Dohme, Ferrer, and GlaxoSmithKline. A.V.N. was supported by NWO-VICI [Netherlands Organisation for Scientific Research] (2002406). The remaining authors have no disclosures to report. Publisher Copyright: © 2022 The Authors.
PY - 2022/9/6
Y1 - 2022/9/6
N2 - 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.
AB - 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.
KW - diagnosis
KW - elderly
KW - pulmonary hypertension
UR - http://www.scopus.com/inward/record.url?scp=85137521048&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/JAHA.121.025143
DO - https://doi.org/10.1161/JAHA.121.025143
M3 - Article
C2 - 36062610
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
M1 - e025143
ER -