الفهرس 
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Abstract
Pulmonary hypertension is a hemodynamic state characterized by resting mPAP of ≥ 25 mm Hg. It is probably affects around 1% of the global population. RHC plays a central role in identifying pulmonary hypertension disorders and it is required to definitively diagnose PAH. RHC is also used to further classify these groups into pre-capillary (groups 1, 3, 4 and 5) or post-capillary (groups 2 and 5) PH populations on the basis of PAWP threshold of 15 mmHg. In addition to its use in diagnosis, RHC provides useful information on the degree of hemodynamic impairment and establishes prognosis. A comparative study was carried out to determine to determine diagnostic role, pitfalls associated, and complications encountered during RHC in suspected cases of PAH and CTEPH. Our study was carried out on 75 Patients with clinical suspicion of PH and CTEPH, recruited during a period of one year from at Chest Department and Cardiology Department, Tanta University Hospitals and Tanta university international Educational Hospital. Including, patients clinically suspected by symptoms and signs to have pulmonary hypertension (unexplained exertional dyspnea, unexplained syncope, and symptoms & signs of right ventricular dysfunction; awakening at night with shortness of breath, cough, edema of lower limbs and rapid irregular heartbeats), patient’s echocardiography showing PAH>35mmHg, patients with history of thrombo-embolic disorder, and patient with hereditary base of PH.
Excluding, patients known to have chest diseases and PH correlated to chest condition, patients known to have Left sided heart failure and PH correlated with cardiac condition, and patients with contraindication to RHC include {Absolute: mechanical tricuspid or pulmonic valve, right heart mases (thrombus or tumor) and right sided endocarditis, and relative: coagulopathy, pacemaker, bio prosthetic tricuspid or pulmonic valve, left bundle branch block, arrhythmias and skin site infection}. Each participant was subjected to: 1) Full history taking, full general examination, full chest examination. 2) Laboratory investigations as complete blood picture, liver function test, kidney function test, coagulation profile and blood gases analysis. 3) Radiological investigations include chest radiograph, HRCT chest and ECG.4) Transthoracic echocardiography. 5) CT angiography to patients suspected to have CTEPH. Our study results have revealed that the mean ± SD age of the examined patients was 36.69 ± 9.569 ranging from 21 to 53 years. 44 patients were females, while 31were males. The mean Body surface ± SD area was 2.08 ± 0.201m2 ranging from 1.69 to 2.44 m. According to NYHA functional class for dyspnea, 66.7% of the patients were class ІІ while 33.3% were class IIІ. The mean Hb of the examined patients was (10.79 ± 1.373) ranging from (8.60 to 12.80), the mean INR was (1.62 ± 0.369) ranging from (0.92 to 2.19), D-dimer was founded to be positive in 6% of the patients. As regards the presenting symptoms, 47 patients (62.7%) presented with chest pain, 67 patients (89.3%) complained of exertional dyspnea, 21 patients (28%) presented with syncope, 39 patients (52%) complained of cough, one patient suffered from hemoptysis, two patients (2.7%) presented with cyanosis, while no patients complained of fever. With reference to examination findings, 27 patients (36%) were presented with Congested Jugular veins, 9 patients (12%) were presented with lower limb edema, while no clubbing or ascites were detected. Regarding the cardiac signs, 36 patients (48%) of patients presented by S3 gallop, 13 patients (17.3%) of patients presented by arrythmia, 10 patients (13.3%) of patients presented by QRS prolongation, 12 patients (16%) of patients presented by prolonged QT interval, 31 patients (41.3%) of patients presented by P pulmonale. Regarding PAH etiology in the examined patients, the most frequent diagnosis of PAH was idiopathic PAH: 44% (n = 33) of all cases followed by PAH due to connective tissue disease 280% (n = 21) followed by congenital heart disease (CHD) 20% (n = 15) followed by chronic thromboembolic pulmonary hypertension 8% (n = 6). Concerning the echocardiographic assessment of pulmonary artery pressure and ejection fraction, it was founded that the mean Doppler PASP of all examined patients (52.69 ± 10.667) ranging from (37 to 47), the mean Doppler PADP was (32.77 ± 7.610) ranging from (22 to 48), the mean Doppler PAMP was (46.05 ± 9.631) ranging from (32 to 65), the mean PAD was (30.04 ± 1.082) ranging from (26.20 to 36.40), the mean ejection fraction was 63.87 % ranging from (56 to 74%), the mean right ventricular diameter was (45.83 ± 0.444) ranging from (41.10 to 48.70). The mean heart rate ± SD was (86.68 ± 13.685 beat/min) ranging from (63 to 107 beat/min), the mean systemic mean blood pressure ±S D was (125.91 ± 15.519 mmHg) ranging from (103 to 166 mmHg). Concerning the right atrium pressure (RAP), the mean systolic RAP ± SD was (10.04 ± 2.738 mmHg) ranging from (5 to 16 mmHg), the mean diastolic RAP ± SD was (3.53 ± 2.796 mmHg) ranging from (0 to 10 mmHg), the mean RAP ± SD was (7.84 ± 2.118 mmHg) ranging from (4 to 14 mmHg). Concerning the right ventricle pressure, the mean systolic RVP ± SD was (49.77 ± 9.986 mmHg) ranging from (31 to 69 mmHg), the mean diastolic RVP ± SD was (8.19 ± 3.907 mmHg) ranging from (1 to 16 mmHg), the mean RV P± SD was (36.03 ± 7.503 mmHg) ranging from (1 to 16 mmHg). With reference to Pulmonary artery pressure PAP, mean systolic PAP±SD was 53.01 ± 11.192 mm Hg (ranging from 35 to 75 mm Hg), mean diastolic PAP±SD was 32.99 ± 8.283 mm Hg (ranging from 20 to 51 mm Hg) and mean PAP±SD was 46.35 ± 10.036 mm Hg (ranging from 30 to 67 mmHg). Moreover, Pulmonary artery wedge pressure PAWP, mean PAWP±SD was 10.91 ± 2.303 mm Hg (ranging from 7 to 15 mmHg). Mean Cardiac output CO ± SD was 4.00 ± 0.773 L/min ranging from 2.41 to 5.57 L/min. mean cardiac index CI ± SD was 1.94 ± 0.416 L/min/m2 ranging from 0.99 to 2.78 L/min/m2). DE-ePASP significantly positively correlated with RHC-PASP (r=0.956; p ˂ 0.001), DE-ePADP significantly positively correlated with RHC-PADP (r=0.972; p ˂ 0.001) and mean DE-ePAP significantly positively correlated with mean RHC-PAP (r=0.973; p ˂ 0.001).