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Diastolic pulmonary gradient predicts outcomes in group 1 pulmonary hypertension (analysis of the NIH primary pulmonary hypertension registry).
- Source :
-
Respiratory medicine [Respir Med] 2016 Oct; Vol. 119, pp. 81-86. Date of Electronic Publication: 2016 Aug 25. - Publication Year :
- 2016
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Abstract
- Background: Diastolic pulmonary gradient (DPG), calculated as the difference between pulmonary artery diastolic pressure and mean pulmonary capillary wedge pressure ≥ 7 mmHg is associated with pulmonary vascular disease and portends poor prognosis in heart failure (HF). The prognostic relevance of DPG in group 1 pulmonary hypertension (PH) is uncertain.<br />Methods: Using the Pulmonary Hypertension Connection (PHC) risk equation for 225 patients in the NIH-PPH, the 5-year probability of death was calculated, which was then compared with DPG using a Cox proportional hazards model. Kaplan-Meier survival curves were determined for two cohorts using the median DPG of 30 mmHg as cutoff, and significance was tested using the log-rank test.<br />Results: The mean age was 38.1 ± 16.0 years old, 63% female, and 72% were "white". The mean DPG was 31.6 mmHg ± 13.8 mm Hg and only 1.8% had a DPG <7 mm Hg. Increasing DPG was significantly associated with increased 5-year mortality even after adjustment for the PHC risk equation (HR 1.29 per 10 mm Hg increase). When DPG was dichotomized based on the median of 30 mm Hg, the HR for DPG >30 mm Hg with respect to 5-year mortality was 2.03. After adjustment for pulmonary artery systolic pressure (PASP), increasing DPG remained significantly associated with decreased 5 years survival (HR 1.99 for DPG > 30 mm Hg).<br />Conclusions: DPG is independently associated with survival in group 1 PH patients even after adjustment for the PHC risk equation or PASP. Patients with increased DPG had a 2-fold increased risk of mortality. The use of DPG for guiding treatment and prognosis in group 1 PH should be further investigated.<br /> (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adolescent
Adult
Cardiac Catheterization
Clinical Trials as Topic
Familial Primary Pulmonary Hypertension mortality
Female
Heart Failure complications
Humans
Hypertension, Pulmonary mortality
Lung physiopathology
Male
Middle Aged
Outcome Assessment, Health Care
Predictive Value of Tests
Prognosis
Pulmonary Wedge Pressure physiology
Registries
Vascular Resistance physiology
Young Adult
Diastole physiology
Familial Primary Pulmonary Hypertension physiopathology
Hypertension, Pulmonary physiopathology
Lung blood supply
Pulmonary Artery physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-3064
- Volume :
- 119
- Database :
- MEDLINE
- Journal :
- Respiratory medicine
- Publication Type :
- Academic Journal
- Accession number :
- 27692153
- Full Text :
- https://doi.org/10.1016/j.rmed.2016.08.024