title: Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy.
abstract: OBJECTIVE
  To ascertain whether pulmonary hypertension, as assessed noninvasively by continuous-wave Doppler of tricuspid regurgitation, can be an important independent factor in the prognosis of patients with ischemic or idiopathic dilated cardiomyopathy.
  
  
  METHODS
  Cohort study of consecutive patients with dilated cardiomyopathy in whom follow-up was obtained on all survivors for 28 months.
  
  
  METHODS
  Outpatient cardiology private practice office in a tertiary care center.
  
  
  METHODS
  Consecutive sample of 108 patients who presented for a scheduled office visit during a 15-month period.
  
  
  METHODS
  M-mode, two-dimensional, and Doppler echocardiographic examinations were done on all patients at entry into the study and on survivors 1 year later. All examinations included extensive pulsed- and continuous-wave Doppler evaluation for tricuspid regurgitation.
  
  
  METHODS
  Overall mortality, mortality due to myocardial failure, and hospitalization for congestive heart failure.
  
  
  RESULTS
  Twenty-eight patients had a high velocity of tricuspid regurgitation (greater than 2.5 m/s), and 80 patients had a low velocity (less than or equal to 2.5 m/s). After 28 months of follow-up, the mortality rate was 57% in patients with a high velocity compared with 17% in patients with a low velocity (difference of 40%, 95% CI, 20% to 60%). Hospitalization for congestive heart failure occurred in 75% and 26% of patients, respectively (difference of 49%, CI, 30% to 68%). Eighty-nine percent of patients with a high velocity either died or were hospitalized compared with only 32% of patients with a low velocity (difference of 57%, CI, 42% to 72%). The peak velocity of tricuspid regurgitation was the only prognostic variable selected using stepwise logistic regression models for the three outcome events.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Lankenau Hospital, Wynnewood, Pennsylvania.
authors.forename: S V
authors.initials: SV
authors.lastname: Abramson
authors.forename: J F
authors.initials: JF
authors.lastname: Burke
authors.forename: J J
authors.initials: JJ
authors.lastname: Kelly
authors.forename: J G
authors.initials: JG
authors.lastname: Kitchen
authors.forename: M J
authors.initials: MJ
authors.lastname: Dougherty
authors.forename: D F
authors.initials: DF
authors.lastname: Yih
authors.forename: F C
authors.initials: FC
authors.lastname: McGeehin
authors.forename: J W
authors.initials: JW
authors.lastname: Shuck
authors.forename: T P
authors.initials: TP
authors.lastname: Phiambolis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000503:physiopathology