Background: Pulmonary hypertension is characterized by an increase in pulmonary vascular resistance and premature death. Echocardiography is useful in the screening of patients with suspected pulmonary hypertension by estimation of the systolic regurgitant tricuspid flow velocity according to the simplified Bernoulli equation. On this basis, the survey INCIPIT was created aiming at evaluating the frequency of suspected pulmonary hypertension among Italian patients.
Methods: From November 10 to 29, 2008, echo laboratories were invited to report on a special electronic file the number of echocardiographic examinations performed and the number of those showing a peak tricuspid regurgitant flow velocity > or = 3 m/s.
Results: 123 echo labs participated in the study. 21 483 echocardiograms were evaluated from 110 centers (58, 17 and 35 in North, Center and South Italy, respectively); 1410 (6.6%) exams showed a systolic regurgitant flow velocity > or = 3 m/s (median value 3.3 and interquartile range 0.46). Patients were predominantly female (female to male ratio 734/676), with a mean age of 71.8 +/- 11.8 years, median body mass index of 25.7 kg/m2 (interquartile range 5.5). Overall, 21.4% patients had no symptoms, 48.7% had dyspnea, 11.2% had asthenia, 3.9% had chest pain, and 7.4% had dyspnea and asthenia. Among the 1410 patients with a tricuspid regurgitant flow velocity > or = 3 m/s, 52.62% had left heart disease, 7.52% lung disease, 1.35% chronic thromboembolic pulmonary hypertension, 0.92% collagen disease, 0.43% congenital heart disease, 0.14% liver disease, 0.07% HIV, 26.45% more than one disease, and 10.5% presented suspected pulmonary hypertension of unknown cause.
Conclusions: In the Italian echo labs, the occurrence of suspected pulmonary hypertension is not uncommon. Cardiologists should be encouraged to refer patients with suspected pulmonary hypertension of unknown origin to specialized centers in order to define the cause of pulmonary hypertension and to institute the appropriate therapy.