Echocardiographic Assessment of Pulmonary Artery Systolic Pressure and Outcomes in Ambulatory Heart Failure Patients

Abstract

BackgroundPulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed.Methods and ResultsWe examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54±13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range [IQR]: 29, 46). After a median follow‐up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10‐mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk.ConclusionsElevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events.

Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction

“…Not only that in the ROC analysis, PASP had the largest AUC to predict a composite outcome of death and hospitalization (Figure ). It is notable that the mean PASP in this study was 39 mm Hg, which is below than the cutoff of 48 mm Hg in the study by Kalogeropoulos et al . for prediction of death, HF hospitalization, and transplantation.…”

Pretransplant echocardiographic parameters as markers of posttransplant outcomes in liver transplant recipients

“…Elevated PASP has been shown to be independently associated with cardiac events in patients with and without heart failure, but it has not previously been reported as a risk factor for cardiac events in patients with cirrhosis. Elevated PASP may be the result of increased left ventricular diastolic pressure and consequently a marker for pretransplant diastolic dysfunction.…”

“…In our cohort, only diabetes was independently associated with posttransplant cardiac events but this is likely due to pretransplant risk stratification that excluded patients with significant cardiovascular disease. Elevated PASP has been shown to be independently associated with cardiac events in patients with 20 and without 21 heart failure, but it has not previously been reported as a risk factor for cardiac events in patients with cirrhosis. Elevated PASP may be the result of increased left ventricular diastolic pressure and consequently a marker for pretransplant diastolic dysfunction.…”

Pulmonary Hypertension in a Large Cohort with Hereditary Hemorrhagic Telangiectasia

“…This prevented patients with clinically diagnosed HHT in whom genetic testing could not detect a disease-causing mutation from being falsely classified as HHTnegative. Subjects without a reliable peak tricuspid regurgitation velocity (TRV) measurement on TTCE were excluded [24,25] .…”