BACKGROUND: Pulmonary hypertension (PH) is a relatively frequent disease and constitutes

the third cause of cardiovascular illness, 1 and it is defined as an excessive increase in resting
mean pulmonary artery pressure (MPAP) ≥ 25 mmHg measured by right heart catheterization
(RHC).1,2,3,4 It can occur in many processes and is divided into five groups according to
aetiology.1,4,5

We analyzed data from patients classified in group III or PH secondary to pulmonary chronic
diseases to understand the characteristics and evolution in these cases. This pathological
condition is closely related to frequent pulmonary diseases such as chronic obstructive
pulmonary disease (COPD) and diffuse interstitial lung diseases (DILD) among others. 6 It is vital
to study the clinical, epidemiological, functional and hemodynamic characteristics to better
focus on therapeutic management.

In most cases, PH of group III is mild to moderate, 6 although its association with the underlying
diseases results in a worse prognosis with higher morbidity and mortality. 4,5

It is difficult to determine whether the symptoms are the result of the underlying respiratory
disease or due to the development of secondary pulmonary hypertension. 6 Symptoms such as
the aggravation of basal dyspnea, the appearance of syncope, headache or malleolar edemas
may be superimposable between the different conditions. 6

The correct diagnosis implies combining functional tests with imaging tests, including
transthoracic echocardiogram (TTE) as the most commonly used. 4,5 Nevertheless, the definitive
diagnosis is given by the right heart catheterization (RHC). 6,7

GOALS: Insight of the clinical and functional characteristics of patients with PH and pulmonary
disease with hypoxia in the Hospital Universitario de Gran Canaria Doctor Negrín (HUGCDN)
area.

An approach to the epidemiological situation of the disease in our environment.

The prevalence and survival rate of severe pulmonary hypertension associated with pulmonary
diseases in our environment.

The comparison of two subgroups of patients with respiratory disease, those who show and
those who do not show PH, in order to draw a profile of the patients who are most likely to
develop this disorder.

METHODS: PARTICIPANTS

This is a descriptive retrospective study of cases and controls selected among the most
relevant cases which attended the monographic consultation on pulmonary hypertension
(MCPH) of north area of the HUGCDN for unexplained dyspnea between 2010 and 2019. 54
patients (8%) out of the 792 patients studied were chosen. 46 patients had PH secondary to
respiratory diseases and 8 patients had respiratory disease but not PH. They were classified
according to the RHC and the pulmonary pathology. All patients with PH who did not belong to
the group III of the classification have been excluded. We also removed patients who did not
have RHC with suspected PH of group III due to the lack of conclusive diagnosis.

DATA COLLECTED IN THE STUDY

Gender, age (as date of birth), date of the diagnostic RHC, weight, size, body surface.
Symptoms: dyspnea (the most frequent symptom) and New York Heart Association Scale
(NYHA), syncope, chest pain, edema of lower limbs, Raynaud’s phenomenon.

Follow-up status: active or deceased, date and cause of death.

Electrocardiogram: sinus rhythm or non-sinus rhythm (atrial fibrillation and atrial flutter).

Blood pressure: systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Transthoracic echocardiogram (TTE): essential diagnostic tool. 1,2 We studied whether the
patients had tricuspid insufficiency and pericardial effusion, as well as the diastolic diameter of
the right ventricle, the ejection fraction of the left ventricle (LVEF), the diastolic eccentricity
index, the Tei Index, the area of the right atrium, the tricuspid annulus plane systolic excursion
(TAPSE) and the systolic pressure of the pulmonary artery (SPAP).

Spirometry: values of forced vital capacity (FVC), forced expiratory volume in the first second
(FEV1), FEV1/FVC Index and the total pulmonary capacity (TPC).

Gait test at 6 minutes: distance travelled, oxygen supplements at the time the test was
performed, arterial saturation at the beginning of gait and saturation at the end of gait.

First RHC and response to the vasodilation test, in which nitric oxide is usually used.

STATISTICAL ANALYSIS

We used IBM SPSS Statistics 24.0.0. Categorical variables were studied as frequencies and
percentages, while numerical variables were analyzed as means and standard deviations. The
means were compared using the t-test giving as valid the statistical significance in p<0.05.
Survival in subgroups with PH was assessed using the Kaplan-Meier method.

ABSTRACT: Background: Pulmonary hypertension (PH) is an excessive increase in the average

pulmonary artery pressure exceeding 25 mmHg. It can be idiopathic or secondary, and within
these we have those caused by respiratory conditions. Although progress has been made in
this field, there is still an arduous task of collecting data that provides a broad perspective of
this disease and translates into improved therapeutics and prognosis.

Goals: Insight into the clinical and epidemiological characteristics of patients with PH
associated to chronic pulmonary diseases and an estimate of the survival in patients of the
north area of HUGCDN.

Methods: Clinical data, echocardiogram and functional characteristics, as well as mortality,

have been retrospectively analyzed in 54 patients with chronic respiratory diseases. We used
information from the first right heart catheterization (RHC) to determine if the patients had PH
or not and we excluded those patients without chronic respiratory disease.

Results: 16 patients had chronic obstructive pulmonary disease (COPD) with PH and 26 had
diffuse interstitial lung disease (DILD) with PH. The remaining 8 had patients with respiratory
disease without PH, 4 subjects with COPD and 4 with DILD. We studied all characteristics
mentioned above and compared the data between the groups with PH, but we found no
significant differences. It was impossible to compare the PH groups with those which did not
have PH because of the small sample size of the second group.

CONCLUSIONS: Group III PH was found to affect 8% of patients studied for dyspnea and the
prevalence of respiratory pathologies in the group of patients with PH was 38% COPD and 62%
DILD, with mean survivals of 2.24 and 3.68 years respectively. No data were identified that
differentiated these two diseases in terms of progression and severity of PH.

Severe pulmonary hypertension in PH in group III accounts for 8% of patients studied for
dyspnea and suspected PH.

Out of patients with secondary PH to chronic lung disease without autoimmune disease, 38%
(n=16) had COPD and 62% (n=26) had DILD.

The survival of patients with severe PH in group III depends on the basic respiratory pathology,
being for DILD between 1 and 7 years (average of 3.78 years) and for COPD between 1-3.5
years (average of 2.24 years).

It has not been possible to demonstrate that any of the two respiratory diseases most often
involved in the development of group III PH, such as DILD and COPD, have differential
characteristics that influence the progression towards it.

REFERENCES

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