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Normal values of pulmonary Normal values of pulmonary artery pressure in young artery pressure in young

healthy subjects – are values healthy subjects – are values similar to the general similar to the general

populationpopulation??

Alon GrossmanAlon Grossman1 1 , Alex Prokupetz, Alex Prokupetz11, Ori Wand, Ori Wand11,,Amit AssaAmit Assa11 ,Michal Benderly ,Michal Benderly2 2 ,, Ofra Kalter-Ofra Kalter-

LeiboviciLeibovici22

1. Aeromedical Center, Israeli Air Force1. Aeromedical Center, Israeli Air Force

22 . .The Gertner Institute for epidemiology and healthy policy The Gertner Institute for epidemiology and healthy policy research affiliated to Tel Aviv University,Tel Hashomer,Israelresearch affiliated to Tel Aviv University,Tel Hashomer,Israel

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Cardiovascular assessment has Cardiovascular assessment has major implication in the medical major implication in the medical screening process of aircrew screening process of aircrew candidates.candidates.

BackgroundBackground

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Cardiovascular screening in the Cardiovascular screening in the Israeli Air Force includes:Israeli Air Force includes: Medical and family historyMedical and family history Physical examinationPhysical examination ElectrocardiogramElectrocardiogram EchocardiographyEchocardiography

BackgroundBackground

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TTE has been validated for the TTE has been validated for the noninvasive assessment of cardiac noninvasive assessment of cardiac structure and function.structure and function.

TR jet peak velocity predicts PASP TR jet peak velocity predicts PASP observed by invasive measurements.observed by invasive measurements.

Normal upper limit of PASP is lower than Normal upper limit of PASP is lower than 30mmHg in studies.30mmHg in studies.

TTE – Transthoracic EchocardiographyTTE – Transthoracic EchocardiographyTR-Tricuspid RegurgitationTR-Tricuspid Regurgitation

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic Pressure

IntroductionIntroduction

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Routine echo studies was preformed Routine echo studies was preformed between 1994-2010.between 1994-2010.

Echo was routinely preformed Echo was routinely preformed beforebefore recruitment to flight academy.recruitment to flight academy.

Echo studies for clinical indications Echo studies for clinical indications were were excluded.excluded.

MethodsMethods

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Control group Control group - 6598 echo were - 6598 echo were interpreted as normal .interpreted as normal .

Study group Study group - 1900 studies - 1900 studies demonstrated TR enabling demonstrated TR enabling measurement of PASP .measurement of PASP .

Values for PASP ranged from Values for PASP ranged from 10+5mmHg to 35+5mmHg10+5mmHg to 35+5mmHg..

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic PressureTR- Tricuspid RegurgitationTR- Tricuspid Regurgitation

ResultsResults

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95%95% limit for PASP was 29+5mmHg limit for PASP was 29+5mmHg (34 mmHg).(34 mmHg).

Upper that Upper that 99%99% limit for PASP limit for PASP was 34+5mmHg (39 mmHg).was 34+5mmHg (39 mmHg).

PASP was correlated with the LVEDPASP was correlated with the LVED and LVES.and LVES.

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic PressureLVED – Left Ventricular End Diastolic DiameterLVED – Left Ventricular End Diastolic Diameter

LVES - Left Ventricular End Systolic DiameterLVES - Left Ventricular End Systolic Diameter

ResultsResults

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Previous studies among normal and Previous studies among normal and heterogeneity population the PASP was heterogeneity population the PASP was reported 26.6-29.3mmHg.reported 26.6-29.3mmHg.

AgeAge is the strongest predictor of PASP, is the strongest predictor of PASP, increase of 1mmHg for every decade of increase of 1mmHg for every decade of age .age .

It is crucial to determine the normal It is crucial to determine the normal range of PASP.range of PASP.

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic Pressure

DiscussionDiscussion

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PASP values may be high as 40mmHq in PASP values may be high as 40mmHq in general population, include obese and general population, include obese and elderly subjects.elderly subjects.

The values of PASP was 34mmHq in 95The values of PASP was 34mmHq in 95thth % % of the subjects in our study.of the subjects in our study.

Higher PASP values may be present in Higher PASP values may be present in young athletes subjects.young athletes subjects.

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic Pressure

DiscussionDiscussion

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A previous study found a correlation A previous study found a correlation between BSA and BP and PASP.between BSA and BP and PASP.

In our study a correlation was found In our study a correlation was found between LVED and LVES and PASP.between LVED and LVES and PASP.

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic PressureBSA – Body Surface AreaBSA – Body Surface Area

BP – Blood PressureBP – Blood PressureLVED – Left Ventricular End Diastolic DiameterLVED – Left Ventricular End Diastolic Diameter

LVES - Left Ventricular End Systolic DiameterLVES - Left Ventricular End Systolic Diameter

DiscussionDiscussion

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The subjects were evaluated at a The subjects were evaluated at a single time point and no follow-up single time point and no follow-up was performed.was performed.

Population evaluated is a highly Population evaluated is a highly selected one, thus preventing selected one, thus preventing generalization to other populations.generalization to other populations.

Study limitationStudy limitation

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Values of PASP in young healthy Values of PASP in young healthy subjects may be higher than those subjects may be higher than those observed in the general population.observed in the general population.

PASP – Pulmonary Artery Systolic PressurePASP – Pulmonary Artery Systolic Pressure

ConclusionsConclusions

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Thank youThank you

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