Prognostic implications of serial assessments of pulmonary hypertension in severe chronic heart failure.
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.
Grigioni
Francesco
F
Cardiology Institute, University of Bologna, Bologna, Italy. francesco.grigioni@unibo.it
Potena
Luciano
L
Galiè
Nazzareno
N
Fallani
Francesco
F
Bigliardi
Mauro
M
Coccolo
Fabio
F
Magnani
Gaia
G
Manes
Alessandra
A
Barbieri
Andrea
A
Fucili
Alessandro
A
Magelli
Carlo
C
Branzi
Angelo
A
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