Association of the metabolic syndrome with pulmonary venous hypertension.
BACKGROUND
Pulmonary venous hypertension (PVH) is a well-described cause of pulmonary hypertension (PH) in patients with left heart disease associated with elevated left heart filling pressure. PVH results from a number of processes, including left-sided valvular disease, constrictive pericardial disease, restrictive cardiomyopathies, and left ventricular (LV) systolic dysfunction. PVH in patients with normal LV systolic function, commonly referred to as diastolic dysfunction, is not well characterized. We observed that many patients with PH due to PVH have obesity, hypertension, diabetes mellitus, and hypercholesterolemia, which are clinical features of the metabolic syndrome (MS), a previously identified cause for systemic vascular disease.


METHODS
We evaluated 122 consecutive patients referred for diagnosis and treatment of PH and compared the prevalence of features of the MS between patients with PVH and those with pulmonary arterial hypertension (PAH). We also compared clinical and hemodynamic characteristics between these two groups.


RESULTS
Compared to patients with PAH, patients with PVH had a higher frequency of hypertension, obesity, diabetes mellitus, and hyperlipidemia. Two or more features of the MS were found in 16 of 17 patients with PVH (94.1%) compared with 34.3% of patients with PAH (p < 0.001; odds ratio, 30.7; 95% confidence interval, 3.6 to 260.0). PH was substantial, but less severe overall, in patients with PVH compared to those with PAH (mean pulmonary artery pressure, 45 +/- 17 mm Hg [range, 26 to 71 mm Hg] vs 53 +/- 10 [range, 33 to 72 mm Hg], respectively [p = 0.041]; and pulmonary vascular resistance, 4.4 +/- 2.9 units [range, 1.2 to 10.8 units] vs 10.8 +/- 4.7 units [range, 4.8 to 21.9 units], respectively [p < 0.001]).


CONCLUSIONS
PVH is highly associated with the MS. Our results suggest that the MS may predispose patients to develop pulmonary vascular disease.
Robbins
Ivan M
IM
Pulmonary Vascular Center, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: ivan.robbins@vanderbilt.edu.
Newman
John H
JH
Pulmonary Vascular Center, Vanderbilt University School of Medicine, Nashville, TN.
Johnson
Roger F
RF
Pulmonary Vascular Center, Vanderbilt University School of Medicine, Nashville, TN.
Hemnes
Anna R
AR
Pulmonary Vascular Center, Vanderbilt University School of Medicine, Nashville, TN.
Fremont
Richard D
RD
Pulmonary Vascular Center, Vanderbilt University School of Medicine, Nashville, TN.
Piana
Robert N
RN
Division of Allergy, Pulmonary and Critical Care Medicine, the Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN.
Zhao
David X
DX
Division of Allergy, Pulmonary and Critical Care Medicine, the Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN.
Byrne
Daniel W
DW
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003971:Diastole; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D008875:Middle Aged; D015995:Prevalence; D011651:Pulmonary Artery; D011667:Pulmonary Veins; D012189:Retrospective Studies; D014690:Venous Pressure; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology