title: Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension.
abstract: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH).
  
  
  
  We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH--in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism--between 2008 and 2013 at our facility.
  
  
  
  During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001).
  
  
  
  The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Francisca
authors.initials: F
authors.lastname: Gavilanes
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: José Leonidas
authors.initials: JL
authors.lastname: Alves
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Fernandes
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Luis Felipe Lopes
authors.initials: LF
authors.lastname: Prada
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Carlos Viana Poyares
authors.initials: CV
authors.lastname: Jardim
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Luciana Tamie Kato
authors.initials: LT
authors.lastname: Morinaga
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Bruno Arantes
authors.initials: BA
authors.lastname: Dias
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Susana
authors.initials: S
authors.lastname: Hoette
authors.affiliation: Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, Brazil. Pulmonary Hypertension Group, Department of Pulmonology, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor/HCFMUSP, Heart Institute/University of São Paulo School of Medicine Hospital das Clínicas - São Paulo, Brazil.
authors.forename: Rogerio
authors.initials: R
authors.lastname: Souza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism; D012129:Respiratory Function Tests; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult
keywords: Cardiac catheterization; Hypertension, pulmonary; Ventricular dysfunction, left