Prognostic value of incidental finding of pulmonary hypertension detected by echocardiography in patients without known cardiovascular or pulmonary disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The estimated overall prevalence of pulmonary hypertension (PHT) is ∼1% in the global population, and up to 10% among patients older than 65 years. PHT is associated with a worst prognosis in patients with cardiovascular or pulmonary disease. However, the significance of PHT as an incidental finding among subjects who do not suffer from cardiac or pulmonary diseases is unknown. The aim of our study is to examine whether incidental diagnosis of PHT in patients without cardiovascular or pulmonary comorbidity is associated with long-term all-cause mortality. Methods This retrospective cohort study included 8296 patients (58% females, mean age, 63 ± 14 years), who performed a first echo study (echo 1) in the years 2006-2009 and a follow up study (echo 2) until 01/2020 in a large single center echo-lab. Patients were excluded if they had evidence of moderate or more left ventricular dysfunction (LVD), significant valvular disease or diagnosis of pulmonary disease at echo 1. The association between PHT and LV function degree (Ejection fraction above or below 55%) to all-cause mortality was examined between four groups [group 1 (G1)- normal LV function (NLV)+ no PTH (NPH), G2- LVD and NPH, G3- NLV and PHT, G4- LVD and PHT] using a Kaplan-Meier analysis and Cox proportional-hazards model, accounting for various covariates. Results Survival time of patients with or without PHT in echo 1 and LV function status at echo 2 was found significantly different among all groups (Pv < 0.001 for all comparisons) (Figure 1). Patients in G1 had the longest mean survival time (141 ± 23 months) compared to any other group (G2-134 ± 30 months, G3-129 ± 32 months, G4-119 ± 38 months). In the multivariable analysis conducted (Table 1), PHT adjusted for various demographic factors and comorbidities was found to be an independent risk factor for long term all-cause mortality with increased risk of up to 34% (adjusted HR-1.34; 95% CI: 1.21-1.47, PV < 0.001). Conclusion Incidental finding of PHT in patients without known cardiovascular or pulmonary disease is an independent risk factor for long term all-cause mortality. Future studies should be conducted to assess the impact of an early diagnosis on all-cause mortality, and the need for further diagnostic and therapeutic steps. Abstract Figure.  Abstract Figure.