Michael E Rezaee1,2, Elizabeth L Nichols2, Mandeep Sidhu3, Jeremiah R Brown2,4,5. 1. Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan. 2. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire. 3. Division of Cardiology, Albany Medical Center, Albany, New York. 4. Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 5. Department of Community and Family Medicine, Lebanon, New Hampshire.
Abstract
BACKGROUND: Pulmonary hypertension (PH) is a well-recognized complication of left ventricular heart failure (HF). HYPOTHESIS: Differences exist in demographic, clinical, hemodynamic, and survival characteristics of patients with left ventricular HF who have combined postcapillary and precapillary PH (CpcPH), isolated postcapillary PH, or no PH. METHODS: A secondary data analysis was conducted using a large prospective database of patients undergoing right heart catheterization from 1994 to 2012. One-year mortality postcatheterization was assessed between PH groups using Kaplan-Meier and log-rank techniques, as well as a multivariate Cox proportional hazards model adjusted for age, sex, diabetes, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease. Mortality rates were calculated for each group as deaths per 100 person-years. RESULTS: Of the 724 patients identified, 29.4% (n = 213) had no evidence of PH, 63.1% (n = 457) had isolated postcapillary PH, and 7.5% (n = 54) had CpcPH. Compared with no PH, there was an increased mortality rate within 1 year for CpcPH patients (crude hazard ratio: 5.22, 95% confidence interval: 2.06-13.22), but not for isolated postcapillary PH patients (crude hazard ratio: 2.12, 95% confidence interval: 0.99-4.57). Adjusted analyses revealed similar results. Mortality rates per 100 person-years were 3.9, 8.4, and 21.0 for no PH, isolated postcapillary PH, and CpcPH patients, respectively. CONCLUSIONS: Heart failure patients with CpcPH are associated with increased death rate 1 year post-cardiac catheterization, compared with patients without PH. They are a high-risk PH group and should be evaluated and diagnosed earlier in the disease state.
BACKGROUND: Pulmonary hypertension (PH) is a well-recognized complication of left ventricular heart failure (HF). HYPOTHESIS: Differences exist in demographic, clinical, hemodynamic, and survival characteristics of patients with left ventricular HF who have combined postcapillary and precapillary PH (CpcPH), isolated postcapillary PH, or no PH. METHODS: A secondary data analysis was conducted using a large prospective database of patients undergoing right heart catheterization from 1994 to 2012. One-year mortality postcatheterization was assessed between PH groups using Kaplan-Meier and log-rank techniques, as well as a multivariate Cox proportional hazards model adjusted for age, sex, diabetes, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease. Mortality rates were calculated for each group as deaths per 100 person-years. RESULTS: Of the 724 patients identified, 29.4% (n = 213) had no evidence of PH, 63.1% (n = 457) had isolated postcapillary PH, and 7.5% (n = 54) had CpcPH. Compared with no PH, there was an increased mortality rate within 1 year for CpcPHpatients (crude hazard ratio: 5.22, 95% confidence interval: 2.06-13.22), but not for isolated postcapillary PH patients (crude hazard ratio: 2.12, 95% confidence interval: 0.99-4.57). Adjusted analyses revealed similar results. Mortality rates per 100 person-years were 3.9, 8.4, and 21.0 for no PH, isolated postcapillary PH, and CpcPHpatients, respectively. CONCLUSIONS:Heart failurepatients with CpcPH are associated with increased death rate 1 year post-cardiac catheterization, compared with patients without PH. They are a high-risk PH group and should be evaluated and diagnosed earlier in the disease state.
Authors: S Ghio; A Gavazzi; C Campana; C Inserra; C Klersy; R Sebastiani; E Arbustini; F Recusani; L Tavazzi Journal: J Am Coll Cardiol Date: 2001-01 Impact factor: 24.094
Authors: Jesper Kjaergaard; Dilek Akkan; Kasper Karmark Iversen; Erik Kjoller; Lars Køber; Christian Torp-Pedersen; Christian Hassager Journal: Am J Cardiol Date: 2007-03-08 Impact factor: 2.778
Authors: Thomas P Cappola; G Michael Felker; W H Linda Kao; Joshua M Hare; Kenneth L Baughman; Edward K Kasper Journal: Circulation Date: 2002-04-09 Impact factor: 29.690
Authors: Carolyn S P Lam; Véronique L Roger; Richard J Rodeheffer; Barry A Borlaug; Felicity T Enders; Margaret M Redfield Journal: J Am Coll Cardiol Date: 2009-03-31 Impact factor: 24.094
Authors: Julio D Duarte; Mayank Kansal; Ankit A Desai; Katherine Riden; Meghan J Arwood; Alex A Yacob; Thomas D Stamos; Larisa H Cavallari; Roham T Zamanian; Sanjiv J Shah; Roberto F Machado Journal: Pulm Circ Date: 2018 Apr-Jun Impact factor: 3.017
Authors: Bin Q Yang; Tufik R Assad; Jared M O'Leary; Meng Xu; Stephen J Halliday; Reid W D'Amico; Eric H Farber-Eger; Quinn S Wells; Anna R Hemnes; Evan L Brittain Journal: Pulm Circ Date: 2018-02-26 Impact factor: 3.017