Background .– Because pulmonary hypertension (PH) seriously worsens prognosis of patients with EF < 35%, new drugs are currently being tested to improve hemodynamic and outcomes. The purpose of this work is to establish the prevalence and determinants of PH in an echo core lab.

Methods .– Between 01/01/2009 and 31/12/2009, all patients scanned in our echo core lab were divided into 2 groups on the basis of EF and then dichotomized based on the tricuspid regurgitation velocity (TRV > 3m/s, i.e. high prevalence of PH). In the subset group of patients with EF < 35%, we randomly selected 97 patients for left ventricular systolic and diastolic function measurement, mitral regurgitation quantification, left atrial volume calculation as well as TRV and right ventricular function assessment.

Results .– From 5658 echocardiography studies, 731 patients (13%) had EF < 35%. Among these 731 patients, TRV was undetectable in 34%, < 3m/s in 38% and > 3m/s in 28% of patients. Of the 97 patients carefully investigated, left atrial area ( p < 0.0001), E velocity ( p < 0.0001), A velocity ( p = 0.0004), E/A ratio ( p < 0.0001), S longitudinal velocity at mitral valve level ( p = 0.007), E/E’ ratio ( p < 0.0001), mitral regurgitation severity (p < 0.0001) and left ventricular pre-ejection time ( p = 0.0002) were univarietely but not independently correlated to TRV. Left ventricular dimensions and EF were not correlated to TVR. From multiple regression analysis, the 2 residual determinants of TVR were left atrial area ( p = 0.02) and mitral regurgitation severity ( p = 0.02).

Conclusion .– Pulmonary hypertension is prevalent in patients with EF < 35%. Both mitral regurgitation severity and left atrial dilation were the strongest determinants of pulmonary hypertension. They should be considered in the future for specific therapeutic approach.