Pulmonary hypertension diagnosis

Posted by stantheman68 @stantheman68, Wed, Apr 22 10:44pm

Hi. I'm Stan. I recently had an echocardiogram and was wondering if what I saw on the report meant I may have pulmonary hypertension. It said: pulmonary artery systolic pressure calculated from tricuspid regurgitation jet is 30 mmHg. Any help would be appreciated!

Hi Stan

If that was an accurate resting measurement then I would assume that you have mild pulmonary arterial hypertension. However, estimations of the degree of PAH from echo data are not necessarily reliable and you would have to submit to invasive right-heart catheterization, which does carry a degree of risk, including that associated with radiation exposure, to get any result that you could have confidence in. There is a good amount of academic literature available on this issue. A useful starting point is the analysis of the REVEAL Registry data conducted by H. W. Farber et al (Congest Heart Fail. 2011 Mar-Apr;17(2):56-64. doi: 10.1111/j.1751-7133.2010.00202.x. Epub 2011 Jan 27). Echo-measured PASP and RHC-calculated PASP can be poorly correlated. I was panicked for months by repeated echo-based calculations of severe PAH only to find out at RHC that my PAH was actually in the mild range. In the last few years my PASP estimations derived from resting echocardiography have yo-yoed so far up and down that I wonder these days if it's really worth keeping my appointments for echo studies. Some cardiac conditions carry an elevated risk of acquiring PAH. But, according to R. J. Barst et al in the Journal of the American College of Cardiology (2004), even perfectly healthy people over 50 years of age can sometimes, if not often, have a PASP >40 mgHH. I hope that this all makes sense to you.

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Outstanding information! Thank you very much.

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@dcacbtcfmc

Hi Stan

If that was an accurate resting measurement then I would assume that you have mild pulmonary arterial hypertension. However, estimations of the degree of PAH from echo data are not necessarily reliable and you would have to submit to invasive right-heart catheterization, which does carry a degree of risk, including that associated with radiation exposure, to get any result that you could have confidence in. There is a good amount of academic literature available on this issue. A useful starting point is the analysis of the REVEAL Registry data conducted by H. W. Farber et al (Congest Heart Fail. 2011 Mar-Apr;17(2):56-64. doi: 10.1111/j.1751-7133.2010.00202.x. Epub 2011 Jan 27). Echo-measured PASP and RHC-calculated PASP can be poorly correlated. I was panicked for months by repeated echo-based calculations of severe PAH only to find out at RHC that my PAH was actually in the mild range. In the last few years my PASP estimations derived from resting echocardiography have yo-yoed so far up and down that I wonder these days if it's really worth keeping my appointments for echo studies. Some cardiac conditions carry an elevated risk of acquiring PAH. But, according to R. J. Barst et al in the Journal of the American College of Cardiology (2004), even perfectly healthy people over 50 years of age can sometimes, if not often, have a PASP >40 mgHH. I hope that this all makes sense to you.

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Hello again, Stan

Sorry, I forgot to suggest this first time. If you are worried, I recommend that you ask for a six-minute walk test. These tests are relatively cheap to get and might set your mind at rest very quickly. I proceeded to RHC on the basis of echo-derived estimations of PASP, electrocardiograms, x-rays and some finger pulse-oximetry. I did not know anything about the full battery of testing that should occur before a patient with suspected PAH gets anywhere near a cath lab. But, 18 months after the event, a new specialist recommended a 6MWT. And I discovered that, even with mild PAH, in terms of distance I did better, considerably better, than the average performance in my studied age and gender matched cohort. While oxygen saturation did drop ca.9% during the test, it also returned to baseline rapidly. If only that test had happened at the very beginning!

Thanks to poppy0344 for the compliment too.

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@stantheman68 Welcome to the Heart & Blood group. It can be scary reading reports without getting a specific interpretation or diagnosis from your physician/cardiologist. I would urge you to reach out to him/her and ask specifically if your echo report indicates pulmonary hypertension. I can tell you from personal experience that the first time I saw a family member's ejection fraction (45%) on an echo report, I was very worried that it meant his heart was working at less than 50%, when in fact, that was not the case. When in doubt, always check with the healthcare provider. Could you check back with this group when you’ve learned more information? I'd like to hear how this turns out for you.

I would also like to remind the community that we aren't here to diagnose or treat, but to share our experiences and our support for one another. As stated in Connect's disclaimer statement, "All information shared by members on the Mayo Clinic Connect, such as messages, images, advice, URLs, and any other material, is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have read on the community." https://connect.mayoclinic.org/page/about-connect/tab/disclaimer/

Our goal is to keep you and the members of the community safe.

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