Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohortHeart (2012)
Background: Pulmonary hypertension (PHT) lacks
community prevalence and outcome data.
Objective: To characterise minimum ‘indicative’
prevalences and mortality data for all forms of PHT in
a selected population with an elevated estimated
pulmonary artery systolic pressure (ePASP) on
Design Observational cohort study.
Setting: Residents of Armadale and the surrounding
region in Western Australia (population 165 450) referred
to our unit for transthoracic echocardiography between
January 2003 and December 2009.
Results Overall, 10 314 individuals (6.2% of the
surrounding population) had 15 633 echo studies
performed. Of these, 3320 patients (32%) had
insufficient TR to ePASP and 936 individuals (9.1%, 95%
CI 8.6% to 9.7%) had PHT, defined as,
ePASP>40 mm Hg. The minimum ‘indicative’
prevalence for all forms of PHT is 326 cases/100 000
inhabitants of the local population, with left heart
disease-associated PHT being the commonest cause
(250 cases/100 000). 15 cases of pulmonary arterial
hypertension/100 000 inhabitants were identified and an
additional 144 individuals (15%) with no identified cause
for their PHT. The mean time to death for those with
ePASP >40 mm Hg, calculated from the first recorded
ePASP, was 4.1 years (95% CI 3.9 to 4.3). PHT increased
mortality whatever the underlying cause, but patients
with PHT from left heart disease had the worst prognosis
and those with idiopathic pulmonary arterial hypertension
receiving disease-specific treatment the best prognosis.
Risk of death increased with PHT severity: severe
pulmonary hypertension shortened the lifespan by an
average of 1.1 years compared with mild pulmonary
Conclusions In this cohort, PHT was common and
deadly. Left heart disease was the most common cause
and had the worst prognosis and treated pulmonary
arterial hypertension had the best prognosis.
Citation InformationStrange, G., Playford, D., Stewart, S., Deague, J., Nelson, H., Kent, A., and Gabbay, E. (2012). Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort. Heart, 98(24), 1805-1811. DOI: 10.1136/heartjnl-2012-301992