Medicine (Baltimore). 2026 Oct 2;105(40):e50924. doi: 10.1097/MD.0000000000050924.
ABSTRACT
Pulmonary hypertension (PH) may occur in diverse clinical contexts. Group 5 PH includes conditions with unclear or multifactorial mechanisms, including tumor-associated PH. Evidence regarding the frequency and clinical significance of elevated right ventricular systolic pressure (RVSP) in patients with mediastinal tumors (MT) is limited. This study aimed to identify clinical and echocardiographic factors associated with elevated RVSP suggestive of PH in patients with MT. This retrospective observational study included patients with MT who underwent transthoracic echocardiography (TTE) at a single tertiary center from January 2010 to December 2019. Clinical variables and echocardiographic parameters were compared between patients with and without elevated RVSP. Echocardiographic signs suggestive of PH were defined as an estimated RVSP ≥ 35 mm Hg; PH was not confirmed by right-heart catheterization. Fifty-five patients (mean age, 62 ± 13 years; 31 women [56%]) were analyzed. Echocardiographic signs suggestive of PH were observed in 21 patients (38%). Twenty-two patients were asymptomatic, and no symptoms were clearly attributable to elevated RVSP. Forty-seven patients (86%) underwent surgery, and 24 (44%) had malignant tumors; elevated RVSP was not associated with malignancy. Patients with elevated RVSP were older than those without elevated RVSP (67 ± 10 vs 59 ± 14 years, P = .017). Smaller left ventricular (LV) end-systolic (29.4 ± 3.6 vs 31.6 ± 3.6 mm, P = .040) and end-diastolic dimensions (4.2 ± 0.3 vs 4.5 ± 0.3 cm, P = .004), and higher LV ejection fraction (LVEF; 69 ± 6% vs 65 ± 5%, P = .019), were associated with elevated RVSP. In exploratory multivariable analysis, older age, smaller LV dimensions, and higher LVEF remained independently associated with elevated RVSP. Elevated RVSP was not significantly associated with clinical symptoms or malignancy. Echocardiographic signs suggestive of PH were relatively common in patients with MT and were associated with older age, smaller LV dimensions, and relatively hyperdynamic LV function. These findings represent echocardiographic associations rather than invasively confirmed PH and require validation in larger prospective studies.
PMID:42826291 | DOI:10.1097/MD.0000000000050924