Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
J Geriatr Cardiol. 2012 Dec;9(4):328-35. doi: 10.3724/SP.J.1263.2012.06191.
Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure.
A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PH was an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51-12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05).
PASP ≥ 36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PH on echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.
经胸超声心动图可用于估测肺动脉收缩压（PASP）。然而，常规超声心动图中升高的 PASP 的意义尚不确定。在这项研究中，我们评估了在一个由全科医生直接转诊进行常规门诊（开放接入）超声心动图检查的患者队列中，PASP 升高患者的死亡率和住院率，以进一步分析疑似心力衰竭。
2002 年，我院共对 485 例患者进行了开放接入超声心动图检查。对 485 例患者中的 209 例（43%）连续可测量三尖瓣反流患者进行了队列研究，随访时间至少 5 年，调查住院率和生存率。209 例患者中，62 例（30%）患有肺动脉高压（PH）。PH 患者更有可能有 4 次或更多的住院（22%比 8%；P < 0.01）和超过 5 年 30 天的累计住院时间（29%比 13%；P < 0.01）。PH 与死亡率显著相关（P = 0.003），而中重度 PH 是死亡率的独立预测因素（风险比：4.31；95%置信区间（95%CI）：1.51-12.30）。国家统计局的记录显示，PH 患者更有可能将慢性肺部疾病记录为死亡的直接或促成原因（50%比 14%；P < 0.05）。
常规超声心动图上的 PASP ≥ 36mmHg 与反复住院、延长住院时间和增加死亡原因有关。因此，超声心动图上 PH 的诊断值得进一步临床评估，未来的研究旨在确定合适的诊断策略。
