الفهرس 
: Coronary Artery DiseaseOnly 14 pages are availabe for public view
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Abstract
P
ulmonary hypertension (PHT) is a relatively common finding in patients with coronary artery disease (CAD) and is usually associated with increased morbidity and mortality. However, the development of PHT in CAD is highly variable, and contributing factors are not fully understood. Although initial studies focused on patients with reduced left ventricular ejection fraction, more recent studies have shown left ventricular diastolic dysfunction is the most common cause of PH (Yoko et al., 2012).
LA size and volume acts as a predictor to PHT and to the adverse outcome in the general population and in selected clinical conditions as in stroke, atrial fibrillation and heart failure. Moreover it reflects severity of diastolic dysfunction (Stefano et al., 2012).
Pulmonary hypertension (PHT) secondary to heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized cause of PH due to an emerging epidemic of HFpEF. The mechanisms underlying the pathogenesis of PH in HFpEF are not well established, but the presence of PH and right ventricular dysfunction in HFpEF is associated with worse prognosis (Thenappan et al., 2015).
Pulmonary hypertension has long been known to be a serious complication of mitral valve disease (MVD). Yet, its precise role in the natural history and management of patients with MR remains scantly investigated (Patel et al., 2014).
The aim of the study was to determine prevalence and predictors of PHT among coronary artery disease patients by Echocardiography.
Our study included 121 patients who were referred to echocardiography lab for measurement of EF (M-Mode, Sim, Eye bal), LAA (Max-4CH-2CH), LAV (Max-Min), E/A ratio, E’, E/E’, DT, MR jet area, TRPG, IVC diameter also to calculate from such parameters LAV, LAEF, MR grading, DD grading, RVSP to determine whose with PHT and divide them to two groups then PHT group sub-divided into two groups according to severity of PHT (Mild-PHTN and Mod-PHT).
In comparing two major groups, PHT and Normal PAP, there were a statistically significant factors in relation to PHT as Diabetes, use of Digoxin and use of Diuretics where Diuretic use, DM act as an independent predictor to PHT while in comparing minor groups to NO-PHT group; DM, Hyperlipedemia and use of diuretics were significant with also use of diuretics as an independent predictor to PHT among both sub-groups in addition to DM as independent predictor with use of Digoxin to be significant among MOD-PHT group and non-significant among Mild-PHT group.
Also echocardiographic data showed systolic dysfunction (decreased EF), Diastolic Dysfunction, LAV –LAA increase and LAEF decrease and functional Mitral Regurgitation in a significant relation and act as predictors to PHT with difference between groups as incidence of moderate increase in LAA-LAV, advanced grades of DD and increased severity of MR more prominent in major PHT group and among Mild-PHT group than Mod-PHT group while a poorer EF more prominent among Mod-PHT group than Mild-PHT group, this with LAV as independent predictor of PHT among major PHT group and Mild-PHT group in comparison to NO-PHT group.
In both groups other risk factors as smoking, Hypertension, obesity and other drugs as Nitrates, Beta-Blockers, ACEI, ASA also demographic data as( Age-Sex-BSA) showed no significant relation to PHT and difference between groups.