Occult pulmonary hypertension in patients with previous tuberculosis: a pilot study

Miri, Anisa
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Introduction: Pulmonary tuberculosis (PTB) has a large worldwide burden and despite successful treatment can lead to permanent lung damage and pulmonary hypertension (PH). PH in the absence of significant lung damage is also seen to occur, leading respiratory physicians to question whether pulmonary TB may cause pulmonary arterial hypertension (World Health Organization – WHO class 1 PAH) due to a TB Associate’s arteritis of the pulmonary artery, an entity not otherwise described. Methods: We undertook a pilot study in which 20 individuals with previously treated pulmonary TB and no other underlying risk factors for the development of PH underwent electrocardiograph (ECG), chest radiography (CXR), lung function tests and echocardiography (ECHO). Data from these non-invasive investigations was evaluated in determining findings suggestive of PH. Results: At a median duration of 30 months from diagnosis of TB, no patients had ECHO findings suggestive of PH (PAP ≥ 40 mmHg). However, there was a trend towards a negative correlation between the time from diagnosis and right ventricular dysfunction assessed by measuring a tricuspid annular plane systolic excursion (TAPSE; r = -0.5136, p=0.0205). Furthermore, 7 individuals (35%) had one or more ECG features supporting PH and 17 individuals (85%) demonstrated at least one CXR feature of PH respectively. Conclusion: Further studies are needed in order to examine the entity of PAH secondary to previously treated PTB. Although our study did not demonstrate echo findings supporting PH, ECG and CXR modalities were suggestive. Therefore, larger cohorts utilizing more sensitive modalities such as CT chest are required
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine, 2021