On the World Symposia on Pulmonary Hypertension in 2018 in Nizza, the most significant and controversial recommendation has been the adjustment of the definition of pulmonary hypertension to mean pulmonary artery pressure of 20 mmHg. However, whether this definition is sufficient, is still not well known and has to be proven. This study aims to investigate hemodynamic conditions in healthy patients who underwent hemodynamic examinations during patent foramen ovale closure.
Methods: A retrospective analysis of all patients who underwent patent foramen ovale or atrial septal defect closure following cardiac embolism in our hospital between 1999 and 2017 was performed. All patients received hemodynamic examinations during procedure.
Results: Between 1999 and 2017, 1646 patients underwent patent foramen ovale or atrial septal defect closure accompanied by hemodynamic examinations. Patients with lacking parameters such as mean pulmonary artery pressure (Pam), pulmonary wedge pressure (or mean left atrial pressure (LAm)) and cardiac index and patients with known comorbidities (diabetes, arterial hypertension, coronary artery disease, atrial fibrillation) were excluded from the final analysis. Thus, 762 patients were included into the final analysis. Mean age was 42.3 ± 13.4 years and 57% of the patients were female. In terms of hemodynamic parameters, mean PAm was 16.1 ± 4.8 mmHg with a mean LAm of 7.9 ± 3 mmHg, a cardiac index of 2.5 ± 1.64 l/min/m² and a pulmonary vascular resistance (PVR) of 103.6 ± 55.8 dynes/sec/cm-5. In a gender comparison, male patients showed a significantly lower pulmonary vascular resistance (PVRfemale: 107.3 ± 61.8 dynes/sec/cm-5 vs. PVRmale 95.6 ± 45.9 dynes/sec/cm-5; p=0.038). Additionally, a differentiated age analysis by dividing patients into 10-year percentiles and into young and elderly population groups (<50 years vs. ≥ 50 years) showed that hemodynamic parameters increase with age and differ significantly (Table 1 and Table 2).
Discussion/Conclusion: In general, our data confirmed the new hemodynamic definition of pulmonary hypertension. However, hemodynamic parameters worsen significantly with age, so that aged-adjusted normal values should be developed for a better assessment of hemodynamics.
Table 1: Comparison of hemodynamic parameters in young and elderly patients
Table 2: Development of hemodynamic parameters over time
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