Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure

Damy, Thibaud; Goode, Kevin; Kallvikbacka‐Bennett, Anna; Lewinter, Christian; Hobkirk, James; Nikitin, Nikolay P.; Dubois‐Randé, Jean‐Luc; Hittinger, Luc; Clark, Andrew L.; Cleland, John G.F.

doi:10.1093/eurheartj/ehq245

Cited by 163 publications

(133 citation statements)

References 25 publications

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“…Forty full‐text articles were assessed for eligibility (Figure 1). Fifteen (8 RHC and 7 echocardiography) studies were included in the meta‐analysis 2, 3, 4, 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20. The characteristics of the included studies are shown in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Studies included in this analysis are Valerio et al,10 Heresi et al,11 Kovacs et al,5 Suzuki et al,12 Maron et al,3 Takahashi et al,13 Douschan et al,4 Assad et al,2 Abramson et al,14 Kjaergaard et al,15 Shalaby et al,16 Lam et al,17 Damy et al,18 Cabrita et al,19 and Choudhary et al 20. CI indicates confidence interval; M‐H, Mantel‐Haenszel; RHC, right heart catheterization.…”

Section: Resultsmentioning

confidence: 99%

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Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Kolte

Lakshmanan

Jankowich

et al. 2018

JAHA

102

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BackgroundRecent studies have demonstrated a continuum in clinical risk related to mean pulmonary artery pressure that begins at >19 mm Hg, which is below the traditional threshold used to define pulmonary hypertension (PH) of 25 mm Hg. Because of the implications on patient diagnosis and prognosis, the generalizability and validity of these data need further confirmation.Methods and ResultsDatabases were searched from inception through January 31, 2018, to identify studies comparing all‐cause mortality between patients with mildly elevated mean pulmonary artery pressure near but <25 mm Hg versus the referent group. The meta‐analysis included 15 nonrandomized studies and 16 482 patients (7451 [45.2%] with measured or calculated mean pulmonary artery pressure of 19–24 mm Hg by right heart catheterization [n=6037] and echocardiography [n=1414] [mild PH]). The mean duration of follow‐up was 5.2 years. Compared with the referent group, mild PH was associated with an increased risk of mortality (risk ratio, 1.52; 95% confidence interval, 1.32–1.74; P<0.001; I2=47%). Secondary analysis using risk‐adjusted time‐to‐event estimates showed a similar result (hazard ratio, 1.19; 95% confidence interval, 1.09–1.31; P<0.001; I2=42%). The findings were consistent between subgroups of right heart catheterization and echocardiography studies (P interaction>0.05). There was evidence of publication bias; however, this did not influence the risk estimate (Duval and Tweedie's trim and fill adjusted risk ratio, 1.34; 95% confidence interval, 1.15–1.56).ConclusionsThe risk of mortality is increased in patients with mild PH, defined as measured or calculated mean pulmonary artery pressure >19 mm Hg. These data emphasize a need for diagnosing patients with mild PH with consideration to enrollment in PH clinical studies investigating pharmacological and nonpharmacological interventions to attenuate clinical risk and improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Kolte

Lakshmanan

Jankowich

et al. 2018

JAHA

102

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“…Even though most of patients qualified to HTx have pulmonary artery hypertension, some authors underline neutral influence of PH on their prognosis [12,13]. A possible explanation for this observation is that patients on the waiting list to HTx are highly selected, homogenous with terminal HF, thus limiting the chances for identifying differences.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates

Sobieszczańska−Małek

Zieliński²,

Piotrowski³

et al. 2014

Cardiol J

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“…18 Other common techniques used are DTI derived s´ wave velocity, fractional area change and Tei index (which also evaluates diastolic function).…”

Section: Right Ventricular Functionmentioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure

Abstract: Using a definition of PASP > 45 mmHg, 7% of the patients with HF have PAH, which is associated with worse LV function, MR, and prognosis. Whether PAH is a target for therapy in this population remains to be elucidated.

Cited by 163 publications

References 25 publications

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates

Novel Imaging Techniques for Heart Failure

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