Prognostic Value of Pulmonary Hypertension as an Incidental Finding Detected by Echocardiography in Patients Without Known Cardiovascular or Pulmonary Diseases

TL;DR

This study shows that finding pulmonary hypertension by chance in people without heart or lung disease is linked to higher long-term death risk.

Contribution

The study identifies pulmonary hypertension as an independent mortality risk in individuals without known cardiovascular or pulmonary diseases.

Findings

Pulmonary hypertension was associated with a 34% increased risk of all-cause mortality.

Severe pulmonary hypertension doubled the risk of all-cause mortality.

A cutoff of sPAP > 40 mmHg was linked to worsening pulmonary pressure over time.

Abstract

Aims: The global prevalence of pulmonary hypertension (PHT) among the elderly population aged 65 years and above is estimated to be 10%. While it is known to be associated with poor prognoses in patients with cardiovascular or pulmonary diseases, the significance of PHT as an incidental finding among individuals without these conditions remains unclear. The aim of this study was to investigate the relationship between incidental PHT detected by echocardiography and long-term all-cause mortality in patients without known cardiovascular or pulmonary diseases. Methods and Results: This retrospective, single-center cohort study included 8283 patients who underwent two consecutive echocardiographic examinations evaluating pulmonary pressure by assessing the maximal velocity of the tricuspid regurgitation jet. In total, 1705 (20.6%) patients were found to have PHT during the first echocardiography. Using a Cox proportional hazard model for all-cause mortality, PHT was found to be a significant and independent risk factor for all-cause mortality, increasing the risk by 34% (Adj. HR—1.34, 95% CI 1.21–1.47, p < 0.001). There was a direct relationship between PHT severity and long-term all-cause mortality, with patients with severe PHT having a two-fold higher risk compared to those with normal pulmonary blood pressure (Adj. HR—2, 95% CI: 1.58–2.54, p < 0.001). A “cutoff point” of sPAP > 40 mmHg was established, where pulmonary pressure values remained high and even worsened over time (p < 0.001). Conclusions: The incidental diagnosis of PHT by echocardiography in patients without known cardiovascular or pulmonary diseases is an independent risk factor for long-term all-cause mortality. Patients with sPAP ≥ 40 mmHg warrant a comprehensive clinical assessment.

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