Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

Abstract

Objectives: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. Results: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. Conclusions: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.

The Effect of Age on Right Ventricular Diastolic Function Parameters

“…We read with great interest the article by Leibowitz et al [1]. They aimed to explore pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old.…”

“…An E/E' ratio ≥4 had high sensitivity and specificity for predicting right atrial pressure ≥10 mm Hg in intensive care unit patients without cardiac surgery [3]. The study by Leibowitz et al [1] did not evaluate RV Doppler parameters. Further studies should be performed to assess the correlation between age and RV tissue Doppler diastolic parameters such as the tricuspid E/E' ratio.…”

Response to the Paper by Demirkol et al. Entitled &#8216;The Effect of Age on Right Ventricular Diastolic Function Parameters'

“…We agree that echocardiographic assessment of right ventricular diastolic function has potential utility in many clinical scenarios including the effect of aging on cardiac and pulmonary function. Unfortunately, these parameters were not systemically examined in our study cohort [2]. We join with Demirkol et al [1] in calling for future studies to assess the effect of aging on right ventricular diastolic function.…”