Geoff Strange1, Simon Stewart2, David S Celermajer3, David Prior4, Gregory M Scalia5, Thomas H Marwick6, Eli Gabbay7, Marcus Ilton8, Majo Joseph9, Jim Codde7, David Playford7. 1. University of Notre Dame, Fremantle, Western Australia, Australia. Electronic address: gstrange@neda.net.au. 2. University of Cape Town, Cape Town, South Africa. 3. Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. 4. University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia. 5. University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia. 6. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. 7. University of Notre Dame, Fremantle, Western Australia, Australia. 8. Menzies School of Health Research, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. 9. Flinders University, Adelaide, South Australia, Australia.
Abstract
BACKGROUND: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. OBJECTIVES: The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n = 313,492). METHODS: The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). RESULTS: The cohort comprised 74,405 men and 83,437 women 65.6 ± 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe (≥60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73; 95% confidence interval: 8.60 to 11.0; p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg; hazard ratio: 1.410; 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg; hazard ratio: 1.979; 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p < 0.001) than those in the lowest quintile. Accordingly, a clear and consistent threshold of increased mortality (including 1- and 5-year actuarial mortality) around an eRVSP of 30.0 mm Hg was evident. CONCLUSIONS: In this large and unique cohort, the prognostic impact of clinically accepted levels of PHT was confirmed. Moreover, a distinctly lower threshold for increased risk for mortality (eRVSP >30.0 mm Hg) indicative of PHT was identified. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index; ACTRN12617001387314).
BACKGROUND: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. OBJECTIVES: The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n = 313,492). METHODS: The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). RESULTS: The cohort comprised 74,405 men and 83,437 women 65.6 ± 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe (≥60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73; 95% confidence interval: 8.60 to 11.0; p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg; hazard ratio: 1.410; 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg; hazard ratio: 1.979; 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p < 0.001) than those in the lowest quintile. Accordingly, a clear and consistent threshold of increased mortality (including 1- and 5-year actuarial mortality) around an eRVSP of 30.0 mm Hg was evident. CONCLUSIONS: In this large and unique cohort, the prognostic impact of clinically accepted levels of PHT was confirmed. Moreover, a distinctly lower threshold for increased risk for mortality (eRVSP >30.0 mm Hg) indicative of PHT was identified. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index; ACTRN12617001387314).
Authors: Jordan B Strom; Varsha K Tanguturi; Sherif F Nagueh; Allan L Klein; Warren J Manning Journal: J Am Soc Echocardiogr Date: 2019-09-25 Impact factor: 5.251
Authors: Nicholas Collins; Stuart Sugito; Allan Davies; Andrew Boyle; Aaron Sverdlov; John Attia; Simon Stewart; David Playford; Geoff Strange Journal: Pulm Circ Date: 2022-10-01 Impact factor: 2.886
Authors: Bradley A Maron; Gabor Kovacs; Anjali Vaidya; Deepak L Bhatt; Rick A Nishimura; Susanna Mak; Marco Guazzi; Ryan J Tedford Journal: J Am Coll Cardiol Date: 2020-12-01 Impact factor: 24.094
Authors: Jacob C Jentzer; Brandon M Wiley; Yogesh N V Reddy; Christopher Barnett; Barry A Borlaug; Michael A Solomon Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-03-16
Authors: Andrew J Swift; Krit Dwivedi; Chris Johns; Pankaj Garg; Matthew Chin; Ben J Currie; Alex Mk Rothman; Dave Capener; Yousef Shahin; Charlie A Elliot; Thanos Charalampopolous; Ian Sabroe; Smitha Rajaram; Catherine Hill; Jim M Wild; Robin Condliffe; David G Kiely Journal: Eur Radiol Date: 2020-04-27 Impact factor: 5.315
Authors: Bradley A Maron; Evan L Brittain; Edward Hess; Stephen W Waldo; Anna E Barón; Shi Huang; Ronald H Goldstein; Tufik Assad; Bradley M Wertheim; George A Alba; Jane A Leopold; Horst Olschewski; Nazzareno Galiè; Gerald Simonneau; Gabor Kovacs; Ryan J Tedford; Marc Humbert; Gaurav Choudhary Journal: Lancet Respir Med Date: 2020-07-27 Impact factor: 30.700
Authors: Alexander Vang; Denielli da Silva Gonçalves Bos; Ana Fernandez-Nicolas; Peng Zhang; Alan R Morrison; Thomas J Mancini; Richard T Clements; Iuliia Polina; Michael W Cypress; Bong Sook Jhun; Edward Hawrot; Ulrike Mende; Jin O-Uchi; Gaurav Choudhary Journal: JCI Insight Date: 2021-06-22