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Prognostic implications of serial assessments of pulmonary hypertension in severe chronic heart failure.
- Source :
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2006 Oct; Vol. 25 (10), pp. 1241-6. Date of Electronic Publication: 2006 Sep 07. - Publication Year :
- 2006
-
Abstract
- Background: It is unknown whether time-related changes of pulmonary hypertension (PH) have prognostic relevance in severe chronic heart failure (CHF).<br />Methods: All CHF patients referred for follow-up from 1996 through 2003 were screened for this study. Eligibility depended on availability of a concomitant clinical, laboratory, electrocardiographic (ECG), echocardiographic and right-heart catheterization (RHC) assessment at index evaluation, as well as absence of pre-capillary PH.<br />Results: One hundred ninety-six patients (age 54 +/- 9 years; 27% women, 73% men; 50% in New York Heart Association [NYHA] Class III or IV) were included. PH at index evaluation was an independent predictor of acute heart failure or cardiovascular death (AHF/CD), with adjusted risk ratio (RR) = 2.30, 95% confidence interval (CI) 1.42 to 3.73 and p < 0.001. A pre-study (> or =6 months) RHC was available for 174 of the 196 patients. Worsening of mean pulmonary artery pressure (mPAP) of > or =30% (a pre-specified cut-off corresponding to the 75th percentile of DeltamPAP%) provided prognostic information independent of all index-evaluation parameters (adjusted RR = 2.60, 95% CI 1.45 to 4.67, p = 0.001), and from time-related changes in the other hemodynamic parameters (p < or = 0.033).<br />Conclusions: PH retains independent prognostic significance even after adjusting for a large set of clinical/laboratory/instrumental parameters. Furthermore, serial measurements of mPAP seem to provide additional prognostic information as compared with a single assessment. These findings indicate that serial evaluations of PAP may help identify a sub-set of high-risk CHF patients deserving a particularly close follow-up to facilitate timely indications for non-pharmacologic strategies, including (when appropriate) heart transplantation.
- Subjects :
- Acute Disease
Cardiovascular Diseases mortality
Chronic Disease
Cohort Studies
Female
Humans
Hypertension, Pulmonary diagnosis
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Prognosis
Severity of Illness Index
Blood Pressure
Blood Pressure Determination methods
Cardiac Output, Low physiopathology
Hypertension, Pulmonary physiopathology
Pulmonary Artery physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3117
- Volume :
- 25
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 17045937
- Full Text :
- https://doi.org/10.1016/j.healun.2006.06.015