Clinical Characteristics of Patients Undergoing Right Heart Catheterizations in Community Hospitals

Abstract

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.

Patient and Therapeutic Profiles of Pulmonary Hypertension in Chronic Lung Diseases in Japan: A Cohort Study Using a Claims Database

“…In another study conducted by JRS-approved institutions, Tanabe et al evaluated the status of diagnostic and treatment modalities in patients with PH with respiratory diseases [ 25 ]. It is important to note that although there are studies challenging the usage of ECHO for the diagnosis of PH [ 41 – 43 ], ECHO is used for both the determination of group 1 and group 3 PH in real-world practices both in Japan [ 25 ] and in other countries such as the Netherlands [ 44 ]. ECHO was used for diagnosis in 99% of the institutions, while RHC was used in only 36% of institutions with more than half of the pulmonologists considering RHC as only necessary prior to the initiation of a PAH-specific therapy.…”

Pulmonary Arterial Hypertension in the Elderly: Peculiar Features and Challenges for a Proper Phenotyping Approach

“…A high baseline PAWP cut-off value of 18 mmHg, included in the eligibility criteria from the REVEAL registry, predisposed a high likelihood of misclassifying HFpEF patients as subjects belonging to the PAH phenotype [ 6 ]. Potential pitfalls in distinguishing between pre-capillary and post-capillary PH may predispose several implications on therapeutic approaches in clinical practice [ 10 , 42 ]. This is particularly true for prescription-based databases, such as the COMPERA registry, in which a proportion of patients with a misdiagnosed PH phenotype could have been included by participating physicians [ 7 ].…”

Simultaneous PET and molecular MR imaging of cardiopulmonary fibrosis in a mouse model of left ventricular dysfunction

“…8,9 Multiple tests aid in diagnosing cardiopulmonary disease severity and progression including echocardiogram, 10,11 magnetic resonance imaging, 12,13 and right heart catheterization. 14 However, at the time of diagnosis, the disease has often progressed to an advanced stage, where cardiac function has declined, and cardiopulmonary fibrosis has developed. 15,16 It remains a challenge to detect the early onset of cardiopulmonary fibrosis and measure disease activity/fibrogenesis.…”