The frequency and classification of pulmonary hypertension in patients admitted to the echocardiography laboratory of the third-line university hospital and the effect of tricuspid regurgitation velocity HEİGHT on mortality: 'Akdeniz University' experience

Pulmonary hypertension (PH) is a chronic and progressive disease that can occur as a result of many etiological causes. The aim of our study was grouping patients of according to the etiological causes of pulmonary hypertension who patients fit the definition of high-probability pulmonary hypertension who applied to the echocardiography laboratory during the 5-year period between 01.01.2015 and 31.12.2019 in our center. The aim was to determine the difference in mortality between the all groups, as well as to determine the difference in mortality between the patient group that fit the definition of moderate-probability pulmonary hypertension and the patient group that fit the definition of high-probability PH. The study was started by examining the records of 25944 patients who applied to the echocardiography laboratory between 01.01.2015 and 31.12.2019 and who were in the echocardiography database. Echocardiographically, of the patients are determined low, medium, and high PH probabilities and when the exclusion criteria are excluded, It was continued with 5733 patients with medium probability, which we call Category 1, and 2835 patients with high probability, which we call Category 2. We looked at the difference in mortality between categories 1 and 2 patients, including age, sex, and systolic pulmonary artery pressure data. Mortality was found to be higher in Category 2 patients (49.1%) than in Category 1 patients (31.8%) (p<0.001) and in men (42.1%) than in women (34.4%) (p<0.001). In addition, it was found that mortality increased as age groups increased (p<0.001). In category 2 patients who fit the definition of high-probability PH, echocardiographic classification was made by considering multiple factors such as patients' clinics, risk factors, comorbid conditions, and left atrial diameters. Afterwards, it has been looked at that there was a difference in mortality between 100 these echocardiographic groups based on age, gender, presence of diabetes mellitus, presence of hypertension, smoking factor, presence of chronic kidney disease, presence of coronary artery disease, history of cerebrovascular accident, presence of peripheral artery disease, presence of malignancy, EF and systolic PAP values. As a result of our study; 78.7% (n:2232) of 2835 patients with echocardiographically high probability PH is constituted Group 2, that is, patients with PH secondary to left heart pathology. Then, Group 3 (Lung disease or hypoxia related PH) patients were seen at the rate of 7.5% (n:212). Group 1 (Pulmonary arterial hypertension) ranked 3rd and 4th with close percentages and 4.8% (n:137); Group 4 (PH associated with pulmonary arterial occlusion) was observed in 4.7% (n:132). The least frequent was Group 5 (PH with Uncertain Mechanisms and/or Multiple Factors) with a rate of 0.6% (n:17). Among Category 2 patients, the mortality of Group 3 patients included in our study was 1.84 times higher than Group 2 patients (p<0.001, ci: 1.532-2.220). In the echo classification distribution, the highest mortality rate was 66.5% (n:141) in Group 3 patients, 52.3% (n:1168) in Group 2 patients, then 38.6% (n:51) in Group 4 patients, followed by Group 1 was found in 32.1% (n:44) patients and at least 11.8% (n:2) in Group 5 patients. As a result of our study; age, being male, having diabetes, having hypertension, having a known history of coronary artery disease, smoking, having chronic kidney disease, having an EF value of <40%, accompanying malignancy, and systolic pulmonary artery pressure Being above 45.6 mmHg were the parameters that led to increased mortality in Category 2 patients.