Pulmonary hypertension screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Patients who are considered at high risk for the development of pulmnary hypertension and require periodic screening include:

• Those with a known BMPR2 mutation(Associated with Familial Pulmonary Hypertension).
• Those with Scleroderma spectrum of diseases.
• Those with portal hypertension who are undergoing evaluation for liver transplantation.

The best study for screening patients suspected of having pulmonary hypertension based on history, physical examination, chest x-ray (CXR), and electrocardiogram (ECG) is an Echocardiogram.

These are the parameters that should be evaluated on Echocardiogram:

1. RA and RV enlargement.
2. Reduced RV function.
3. Displacement of the intraventricular septum.
4. Tricuspid regurgitation(TR).
5. Tei index or myocardial performance index (measured by doppler Ultrasound).
6. Pericardial effusion (presence also indicates a higher mortality rate).

The Tei index is an index of combined RV systolic and diastolic function obtained by dividing the sum of both isovolumetric contraction and relaxation intervals by the ejection time.

Evaluation for thromboembolic disease is also appropriate in all patients suspected of having Pulmonary Hypertension.