title: Prognostic implications of serial assessments of pulmonary hypertension in severe chronic heart failure.
abstract: BACKGROUND
  It is unknown whether time-related changes of pulmonary hypertension (PH) have prognostic relevance in severe chronic heart failure (CHF).
  
  
  METHODS
  All CHF patients referred for follow-up from 1996 through 2003 were screened for this study. Eligibility depended on availability of a concomitant clinical, laboratory, electrocardiographic (ECG), echocardiographic and right-heart catheterization (RHC) assessment at index evaluation, as well as absence of pre-capillary PH.
  
  
  RESULTS
  One hundred ninety-six patients (age 54 +/- 9 years; 27% women, 73% men; 50% in New York Heart Association [NYHA] Class III or IV) were included. PH at index evaluation was an independent predictor of acute heart failure or cardiovascular death (AHF/CD), with adjusted risk ratio (RR) = 2.30, 95% confidence interval (CI) 1.42 to 3.73 and p < 0.001. A pre-study (> or =6 months) RHC was available for 174 of the 196 patients. Worsening of mean pulmonary artery pressure (mPAP) of > or =30% (a pre-specified cut-off corresponding to the 75th percentile of DeltamPAP%) provided prognostic information independent of all index-evaluation parameters (adjusted RR = 2.60, 95% CI 1.45 to 4.67, p = 0.001), and from time-related changes in the other hemodynamic parameters (p < or = 0.033).
  
  
  CONCLUSIONS
  PH retains independent prognostic significance even after adjusting for a large set of clinical/laboratory/instrumental parameters. Furthermore, serial measurements of mPAP seem to provide additional prognostic information as compared with a single assessment. These findings indicate that serial evaluations of PAP may help identify a sub-set of high-risk CHF patients deserving a particularly close follow-up to facilitate timely indications for non-pharmacologic strategies, including (when appropriate) heart transplantation.
authors.affiliation: Cardiology Institute, University of Bologna, Bologna, Italy. francesco.grigioni@unibo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Galiè
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallani
authors.forename: Mauro
authors.initials: M
authors.lastname: Bigliardi
authors.forename: Fabio
authors.initials: F
authors.lastname: Coccolo
authors.forename: Gaia
authors.initials: G
authors.lastname: Magnani
authors.forename: Alessandra
authors.initials: A
authors.lastname: Manes
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbieri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fucili
authors.forename: Carlo
authors.initials: C
authors.lastname: Magelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000208:Acute Disease; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D002303:Cardiac Output, Low / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000401:mortality; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D012720:Severity of Illness Index