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. 2021 May 31;11(6):489.
doi: 10.3390/jpm11060489.

Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study-RES-PH Study

Egidio Imbalzano  1 , Marco Vatrano  2 , Alberto Lo Gullo  3 , Luana Orlando  1 , Alberto Mazza  4 , Vincenzo Antonio Ciconte  2 , Vincenzo Russo  5 , Clemente Giuffrida  3 , Pierpaolo Di Micco  6 , Antonio Giovanni Versace  1 , Giuseppe Mandraffino  1 , Giovanni Squadrito  1
Affiliations

Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study-RES-PH Study

Egidio Imbalzano et al. J Pers Med. .

Abstract

Introduction: The actual prevalence of pulmonary hypertension (PH) in Italy is unknown. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) from the regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation.

Objectives: We aimed to evaluate the frequency of suspected PH among unselected patients.

Methods: We conducted a retrospective cross-sectional database search of 7005 patients, who underwent echocardiography, to estimate the prevalence of PH, between January 2013 and December 2014. Medical and echocardiographic data were collected from a stratified etiological group of PH, using criteria of the European Society of Cardiology classifications.

Results: The mean age of the study population was 57.1 ± 20.5 years, of which 55.3% were male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs. 48.7%; p = 0.873). The prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs. 56.8%; p = 0.671). PH is predominant in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction and related with age. PASP was significantly linked with left atrial increase and left ventricular ejection fraction. In addition, an increased PASP was related to an enlargement of the right heart chamber.

Conclusions: PH has a frequency of 4.3% in our unselected population, but the prevalence may be more relevant in specific subgroups. A larger epidemiological registry could be an adequate strategy to increase quality control and identify weak points in the evaluation and treatment of these patients.

Keywords: echocardiography; pulmonary artery systolic pressure; pulmonary hypertension; unselected population.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Histogram distribution of population as a function of PH probability, mean PASP, and gender. In addition, 5674 patients with PASP ≤ 36 mmHg are classified as low probability of PH (87.1%), 559 patients with PASP between 37–50 mmHg are classified as intermediate probability of PH (8.6%), 280 individuals with PASP > 50 mmHg were diagnosed as high probability of PH (4.3%). No significant difference was found between the men and women in each group.
Figure 2
Figure 2
Mean PASP in the study population, classified into five groups, using criteria of the ESC classification. Group 1: Idiopathic PH; group 2: PH in association with left heart disease; group 3: PH related to hypoxic lung disease; group 4: PH due to chronic thrombo-embolic disease (CTEPH); group 5: Miscellaneous. The second group is the most common in our study. A significant difference of mean PASP by group (p < 0.001) is calculated. No significant difference between men and women (p = 0.132).
Figure 3
Figure 3
Distribution of study population by age shows a significative increase in age-related mean PASP (p < 0.0001). No significant difference by sex (p = 0.594).
See this image and copyright information in PMC

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