Original Research Articles

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Journal of Structural Heart Disease, August 2017, Volume 3, Issue 4:102-106
DOI: 10.12945/j.jshd.2017.003.17

Moderate Altitude Is Not Associated with ­Pulmonary Arterial Hypertension in Adult ­Patients Referred for Transcatheter Device ­Closure of Atrial Septal Defects

Jeremy Nicolarsen, MD1,2*, Brett Oestreich, MD1, Sonali S. Patel, MD2, Jamil Aboulhosn, MD3, Wayne J. Franklin, MD4, Joseph Kay, MD1,2

1 Department of Medicine, University of Colorado Hospital, Aurora, Colorado, USA
2 Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado, USA
3 Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
4 Departments of Medicine and Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA


Background: Pulmonary arterial hypertension (PAH) occurs in 6–10% of adults with atrial septal defects (ASDs). Although larger defect size and older age are two risk factors for the development of PAH in these patients, little is known about the impact of elevation. Thus, we aimed to determine whether the incidence of PAH is higher among patients living at moderate altitude who are referred for transcatheter device closure of an ASD.

Methods: Our multicenter, retrospective cohort study included patients at least 18 years of age who were referred for device closure of an ASD (> 4 mm) during a 10-year period (2003–2013). Catheterization records from three centers were reviewed.

Results: Thirty-seven moderate altitude (4983–5633 ft) and 126 low altitude (74–839 ft) patients were identified (p < 0.0001). After controlling for age, living at moderate altitude was associated with a greater likelihood of pulmonary hypertension (odds ratio 2.29, 95% confidence interval 1.01–5.19, p = 0.046), but there was no such association with PAH (p = 0.9).

Conclusion: Patients with ASD living at moderate altitude are more likely to exhibit pulmonary hypertension but not PAH compared with patients living at sea level. Therefore, while moderate altitude can increase pulmonary pressures, it did not contribute to the development of PAH in our cohort of patients with ASDs.


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Cite this article as: Nicolarsen JR, Oestreich B, Patel SS, Aboulhosn J, Franklin WJ, Kay J. Moderate Altitude Is Not Associated with ­Pulmonary Arterial Hypertension in Adult ­Patients Referred for Transcatheter Device ­Closure of Atrial Septal Defects. Structural Heart Disease 2017;3(4):102-106. DOI: 10.12945/j.jshd.2017.003.17

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