Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy

Abramson, Sandra

doi:10.7326/0003-4819-116-11-888

Cited by 293 publications

(185 citation statements)

References 28 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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“…Some authors have reported that patients with HF qualified for HTx have poor survival and that PH has no additive influence on their prognosis [2,9,12,13].…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of reactive pulmonary hypertension in patients with chronic heart failure listed for elective heart transplantation

Sobieszczańska−Małek

Zieliński

Piotrowski³

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Pulmonary hypertension (PH) is recognised in about 60% of patients referred for heart transplantation (HTx), and it influences the patient's prognosis. Aim:To assess the prognostic value of reactive PH in patients listed for elective HTx. Methods:A total of 522 patients were enlisted from the Polish National Registry (POLKARD), listed for HTx, in whom complete haemodynamic data were reported. The endpoint was all-cause death before HTx. Heart transplantation, elective or urgent, was considered as an end of the follow-up (mean follow-up 1.47 ± 1.26 years). Patients were divided into three subgroups: no PH, passive PH, reactive PH taking into account mean pulmonary artery pressure (PAP) of 25 mm Hg, pulmonary capillary wedge pressure (PCWP) 15 mm Hg, and pulmonary vascular resistance (PVR) 3.0 Wood units. Haemodynamic, clinical, echocardiographic, and biochemical assessments (including NT-proBNP, hs-CRP) were performed. The Heart Failure Survival Score (HFSS) was calculated.Results: Estimated death rate was comparable between patients with no PH, passive PH, and reactive PH, despite the fact that the patients with reactive PH had the worst pulmonary haemodynamic scores (mean PAP 38.4 ± 7.8, PCWP 27 ± 7.4 mm Hg and PVR 4.8 ± 1.7 Wood units). In patients with reactive PH, in multifactor Cox analysis only the serum Na level influenced survival. According to the Kaplan-Meier method, patients with reactive PH, with mean PAP ≥ 41.4 mm Hg had the worst prognosis, estimated survival was: one year -83%, two years -65%. Conclusions:Reactive PH is common among patients with chronic HF listed to HTx (28%). It has no further influence on short-term prognosis as compared with patients with no PH and passive PH. Serum Na concentration and mean PAP ≥ 41.4 mm Hg influence the prognosis of patients with reactive PH.

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“…22) Possible mechanisms whereby pulmonary hypertension (PH) could negatively affect the prognosis of chronic HF (CHF) patients include progression of RV dysfunction due to increased afterload, and a negative effect of PH on neurohumoral activation. [31][32][33] In the presence of elevated RV preload or afterload, septic shock, coexistent with LV dysfunction or right coronary artery occlusive disease, the function of RV becomes hemodynamically significant. 34,35) We considered that RV function may determine afterload such as PH and proper contractive ability.…”

Section: )mentioning

confidence: 99%

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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SummaryRight ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent longterm outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≧ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters. (Int Heart J 2011; 52: 119-126)

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Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy

Abstract: Noninvasive assessment of pulmonary hypertension using continuous-wave Doppler of tricuspid regurgitation can predict morbidity and mortality in patients with ischemic or idiopathic dilated cardiomyopathy.

Cited by 293 publications

References 28 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 significance of reactive pulmonary hypertension in patients with chronic heart failure listed for elective heart transplantation

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

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