1. -שמור- 1 1 Normal values of pulmonary artery pressure in young healthy subjects – are values similar to the general population? Alon Grossman 1, Alex Prokupetz 1, Ori Wand 1, Alon Grossman 1, Alex Prokupetz 1, Ori Wand 1, Amit Assa 1,Michal Benderly 2, Ofra Kalter-Leibovici 2 1. Aeromedical Center, Israeli Air Force 2. The Gertner Institute for epidemiology and healthy policy research affiliated to Tel Aviv University,Tel Hashomer,Israel 1

2. -שמור- 2  Cardiovascular assessment has major implication in the medical screening process of aircrew candidates. Background 2

3. -שמור- 3  Cardiovascular screening in the Israeli Air Force includes:  Medical and family history  Physical examination  Electrocardiogram  Echocardiography Background 3

4. -שמור- 4  TTE has been validated for the noninvasive assessment of cardiac structure and function.  TR jet peak velocity predicts PASP observed by invasive measurements.  Normal upper limit of PASP is lower than 30mmHg in studies. 30mmHg in studies. TTE – Transthoracic Echocardiography TR-Tricuspid Regurgitation PASP – Pulmonary Artery Systolic Pressure Introduction 4

5. -שמור- 5  Routine echo studies was preformed between 1994-2010.  Echo was routinely preformed before recruitment to flight academy.  Echo studies for clinical indications were excluded. Methods 5

6. -שמור- 6  Control group - 6598 echo were interpreted as normal.  Study group - 1900 studies demonstrated TR enabling measurement of PASP.  Values for PASP ranged from 10+5mmHg to 35+5mmHg. PASP – Pulmonary Artery Systolic Pressure TR- Tricuspid Regurgitation Results 6

7. -שמור- 7  95% limit for PASP was 29+5mmHg (34 mmHg). (34 mmHg).  Upper that 99% limit for PASP was 34+5mmHg (39 mmHg). was 34+5mmHg (39 mmHg).  PASP was correlated with the LVED and LVES. and LVES. PASP – Pulmonary Artery Systolic Pressure LVED – Left Ventricular End Diastolic Diameter LVES - Left Ventricular End Systolic Diameter Results 7

8. -שמור- 8  Previous studies among normal and heterogeneity population the PASP was reported 26.6-29.3mmHg.  Age is the strongest predictor of PASP, increase of 1mmHg for every decade of age.  It is crucial to determine the normal range of PASP. PASP – Pulmonary Artery Systolic Pressure Discussion 8

9. -שמור- 9  PASP values may be high as 40mmHq in general population, include obese and elderly subjects.  The values of PASP was 34mmHq in 95 th % of the subjects in our study.  Higher PASP values may be present in young athletes subjects. PASP – Pulmonary Artery Systolic Pressure Discussion 9

10. -שמור- 10  A previous study found a correlation between BSA and BP and PASP.  In our study a correlation was found between LVED and LVES and PASP. PASP – Pulmonary Artery Systolic Pressure BSA – Body Surface Area BP – Blood Pressure LVED – Left Ventricular End Diastolic Diameter LVES - Left Ventricular End Systolic Diameter Discussion 10

11. -שמור- 11  The subjects were evaluated at a single time point and no follow-up was performed.  Population evaluated is a highly selected one, thus preventing generalization to other populations. Study limitation 11

12. -שמור- 12  Values of PASP in young healthy subjects may be higher than those observed in the general population. PASP – Pulmonary Artery Systolic Pressure Conclusions 12

13. -שמור- 13 Thank you 13