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Pulmonary pressure a strong predictor of death in patients with HF
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The results of a large, community-based study demonstrated that pulmonary artery systolic pressure is a strong, independent predictor of mortality for patients with HF.
Pulmonary pressures provide “incremental and clinically relevant prognostic information independently of known predictors of outcomes,” researchers wrote in the study.
From 2003 to 2010, researchers recorded pulmonary artery systolic pressure (PASP) in 1,049 residents of Olmsted County, Minn., who presented with HF (mean age, 76 years). Using Doppler echocardiography, patient ejection fraction and diastolic function were also assessed.
Overall, the median PASP was 48 mm Hg. Only 21% of patients had normal pulmonary pressures when the upper limit of pulmonary pressure was defined as 35 mm Hg.
Four hundred eighty-nine patients died during an average follow-up of 2.7 years. Researchers found a “strong positive graded association” between PASP and risk for all-cause mortality. Increased risk for death was associated with increasing PASP. This association was independent of age, sex, comorbidities, ejection fraction and diastolic function. Compared with patients with lower PASP (<41 mm Hg), patients with levels of 41 mm Hg to 54 mm Hg had HR of 1.45 (95% CI, 1.13-1.85); the risk was even higher in patients with PASP of more than 54 mm Hg (HR=2.07; 95% CI, 1.62-2.64) vs. lower levels.
According to other results, when PASP was added to a prognostic model that included age, sex, incident HF status, comorbidity index, anemia, ejection fraction, diastolic function and chronic obstructive pulmonary disease, c-statistic increased from 0.704 to 0.742 (P=.007), integrated discrimination improvement increased 4.2% (P<.001) and net reclassification improvement increased 14.1% (P=.002). These findings indicate that PASP improved prediction of mortality over traditional prognostic factors, according to the researchers.
Results were similar when the researchers examined CV death.
“The present data indicate that pulmonary pressures can be readily assessed by Doppler echocardiography among patients with HF in the community and that pulmonary hypertension is overwhelmingly present in this setting,” the researchers wrote in the study.
In an accompanying editorial, Myung H. Park, MD, of the department of medicine and division of cardiology at the University of Maryland School of Medicine, and Mandeep R. Mehra, MBBS, of the department of medicine and division of cardiology at Brigham and Women’s Hospital, said, “several important observations emerge from this ‘real world’ study.
“The challenge of these findings is that translation to clinical application is difficult, particularly since the underlying pathology is rather variable and therapeutic stance still poorly defined,” Park and Mehra wrote in the editorial. “A combined confluence of epidemiologic, pathophysiologic, cellular and genetic studies will allow us to have a more clear clinical understanding of pulmonary hypertension, its effects on the right ventricle and more precise prognostic and therapeutic underpinnings. Then, and only then, might we be able to level this great leveler.”
For more information:
- Bursi F. J Am Coll Cardiol. 2012;59:222-231.
- Park MH. J Am Coll Cardiol. 2012;59:232-234.
Disclosure: The researchers and editorialists report no relevant financial disclosures.