RESUMO
BACKGROUND: Pulmonary arterial systolic pressure (PASP) can be estimated with transthoracic echocardiography. However, the significance of raised PASP on routine echocardiography is uncertain. In this study, we evaluated the mortality and hospitalization rates of subjects with raised PASP in a cohort of patients referred directly by their general practitioners for routine outpatient (open access) echocardiography for further analysis of suspected heart failure. RESULTS: A total of 485 subjects were referred for open access echocardiography at our hospital in 2002. A cohort of 209/485 (43%) consecutive subjects with measurable tricuspid regurgitation were followed for a minimum of five years investigating hospitalization rates and survival. Some 62 of 209 (30%) subjects had pulmonary hypertension (PH). Subjects with PH were significantly more likely to have four or more hospital admissions (22% vs. 8%; P < 0.01) and > 30 days of cumulative hospital stay over five years (29% vs. 13%; P < 0.01). PH was significantly associated with mortality (P = 0.003), while moderate to severe PH was an independent predictor of mortality (hazard ratio: 4.31; 95% confidence interval (95% CI): 1.51-12.30). Records from the Office of National Statistics revealed that subjects with PH were more likely to have chronic lung diseases recorded as immediate or contributory causes of death (50% vs. 14%; P < 0.05). CONCLUSIONS: PASP ≥ 36 mmHg on routine echocardiography is associated with recurrent hospital admissions, prolonged hospitalizations and increased cause of mortality. Therefore, the diagnosis of PH on echocardiography deserves further clinical evaluation, with future studies designed at defining a suitable diagnostic strategy.
RESUMO
BACKGROUND: Arm span is the closest physiologic measurement to standing height. Increased arm span to standing height ratio, therefore, indicates possible loss of height, which is a feature of aging, often resulting from osteoporosis-related vertebral collapse. We hypothesize that the discrepancy between arm span and height is associated with reduced airflow volumes, severity of dyspnea, and right-sided cardiac structural changes in older individuals with symptoms of dyspnea. METHOD: Patients with conditions investigated with transthoracic echocardiography for suspected heart failure were invited to participate in our study. All subjects were evaluated with a clinical history and physical examination followed by measurements of arm span, standing height, weight, FEV(1), and FVC. RESULTS: Sixty-six subjects aged 71 +/- 10 years were recruited for our study. Arm span to height ratio was significantly negatively correlated with FEV(1) (r = - 0.464; p < 0.001), FVC (r = - 0.479; p < 0.001), and body weight (r = - 0.252; p < 0.05), and positively correlated with the New York Heart Association classification for dyspnea (rho = 0.309; p < 0.05). Female sex, steroid use, inhaled bronchodilators, orthopnea, paroxysmal nocturnal dyspnea, and right heart chamber dilatation were significantly associated with increased arm span to height ratio. CONCLUSION: We have found a significant association between increased arm span to height ratio, reduced respiratory airflow volumes, increased severity of dyspnea, and echocardiographic features of pulmonary heart disease in a group of predominantly elderly subjects with multiple comorbidities. The role of arm span measurements in assessments of airflow volumes in older patients and the association between loss of height and dyspnea now deserve further evaluation.
