Provider recognition and response to echocardiographic findings indicating pulmonary hypertension in the Veterans affairs medical center population.
Provider recognition and response to echocardiographic findings indicating pulmonary hypertension in the Veterans affairs medical center population.
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DOI：
10.4103/2045-8932.113184
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发表时间：
2013-04
影响因子：
2.6
通讯作者：
Elwing JM
中科院分区：
文献类型：
--
作者：
Kingrey JF;Panos RJ;Ying J;Meganathan K;Vandivier R;Elwing JM
PH单独发生或与许多疾病相关。许多经胸超声心动图（TTE）结果提示PH的患者从未接受额外评价。尚未充分评价与PH识别增加相关的患者特征和超声心动图数据。我们回顾性评价了辛辛那提退伍军人事务医疗中心2005年至2006年的TTE报告，以寻找高度提示PH的结果：估计的肺动脉收缩压（sPAP）≥40 mmHg、右心房或右心室（RV）大小增加或RV功能降低。仅纳入左心室射血分数（LVEF）≥50%且无已知PH诊断的患者。患者的特征，TTE结果，供应商的认可率，并随后转诊进行额外的评价进行了评估。在3，960份TTE报告中，共有227份（5.7%）显示了可能的PH结果。提供者在53份（23.4%）报告中承认可能的PH。右心室增大（OR = 5.07，P < 0.001）、右心房内径增大（OR = 6.45，P <0.001）、右心室功能下降（OR = 8.86，P <0.001）和肺动脉压升高（OR = 1.04，对应于肺动脉压每升高1个单位，P < 0.01）是预测肺高压的指标。合并阻塞性睡眠呼吸暂停（OSA）、间质性肺病和呼吸困难的患者也更容易被识别（OR = 3.63，P = 0.021; OR = 10.98，P = 0.004; OR = 2.39，P = 0.007）。确认患者的12个月死亡率为11.3%（7/53），低于未确认患者的25.3%（44/174; P = 0.03）。超声心动图报告显示较高的PAP和右心扩张和功能障碍与可能的PH增加的承认。
PH occurs alone or in association with many disorders. Many patients with transthoracic echocardiography (TTE) findings suggesting PH never receive additional evaluation. Patient characteristics and echocardiographic data associated with increased recognition of PH have not been fully evaluated. We evaluated TTE reports at the Cincinnati Veterans Affairs Medical Center from 2005 to 2006 retrospectively for findings highly indicative of PH: Estimated systolic pulmonary artery pressure (sPAP) ≥40 mmHg, increased right atrial or right ventricular (RV) size, or reduced RV function. Only patients with left ventricular ejection fraction (LVEF) ≥50% and no known diagnosis of PH were included. Patient characteristics, TTE findings, provider recognition rates, and subsequent referral for additional evaluation were assessed. A total of 227 of 3,960 (5.7%) TTE reports revealed findings indicating possible PH. Providers acknowledged possible PH in 53 (23.4%) reports. Recognized PH was predicted by increased RV size (odds ratio (OR) = 5.07, P < 0.001), increased right atrial dimension (OR = 6.45, P < 0.001), decreased RV function (OR = 8.86, P < 0.001), and increased PAP (OR = 1.04 corresponding to each unit increase of PAP, P < 0.01). Patients with comorbid obstructive sleep apnea (OSA), interstitial lung disease, and dyspnea were also more likely to be recognized (OR = 3.63, P = 0.021; OR = 10.98, P = 0.004; OR = 2.39, P = 0.007, respectively). The 12-month mortality rate for recognized patients, 11.3% (7/53), was lower than for unrecognized patients, 25.3% (44/174; P = 0.03). Providers recognized less than one in four patients with echocardiographic evidence suggesting PH. Echocardiography reports revealing higher PAP and right heart dilation and dysfunction are associated with increased acknowledgement of possible PH.
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影响因子：
39.3
作者：
de Torbal, A;Boersma, E;Witteman, JCM
通讯作者：
Witteman, JCM
影响因子：
39.2
作者：
SIGURDSSON, E;THORGEIRSSON, G;SIGFUSSON, N
通讯作者：
SIGFUSSON, N
影响因子：
--
作者：
Swedko, P;Clark, HD;Akbari, A
通讯作者：
Akbari, A
影响因子：
4.3
作者：
Houtchens J;Martin D;Klinger JR
通讯作者：
Klinger JR
影响因子：
13.2
作者：
Coresh, J;Astor, BC;Levey, AS
通讯作者：
Levey, AS