title: Characteristics and outcome after hospitalization for acute right heart failure in patients with pulmonary arterial hypertension.
abstract: BACKGROUND
  Although much is known about the risk factors for poor outcome in patients hospitalized with acute heart failure and left ventricular dysfunction, much less is known about the syndrome of acute heart failure primarily affecting the right ventricle (acute right heart failure).
  
  
  RESULTS
  By using Stanford Hospital's pulmonary hypertension database, we identified consecutive acute right heart failure hospitalizations in patients with PAH. We used longitudinal regression analysis with the generalized estimating equations method to identify factors associated with an increased likelihood of 90-day mortality or urgent transplantation. From June 1999 to September 2009, 119 patients with PAH were hospitalized for acute right heart failure (207 episodes). Death or urgent transplantation occurred in 34 patients by 90 days of admission. Multivariable analysis identified a higher respiratory rate on admission (>20 breaths per minute; OR, 3.4; 95% CI, 1.5-7.8), renal dysfunction on admission (glomerular filtration rate <45 mL/min per 1.73 m2; OR, 2.7; 95% CI, 1.2-6.3), hyponatremia (serum sodium ≤136 mEq/L; OR, 3.6; 95% CI, 1.7-7.9), and tricuspid regurgitation severity (OR, 2.5 per grade; 95% CI, 1.2-5.5) as independent factors associated with an increased likelihood of death or urgent transplantation.
  
  
  CONCLUSIONS
  These results highlight the high mortality after hospitalizations for acute right heart failure in patients with PAH. Factors identifiable within hours of hospitalization may help predict the likelihood of death or the need for urgent transplantation in patients with PAH.
authors: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA. fhaddad@stanford.edu
authors: François
authors: F
authors: Haddad
authors: Tyler
authors: T
authors: Peterson
authors: Eric
authors: E
authors: Fuh
authors: Kristina T
authors: KT
authors: Kudelko
authors: Vinicio
authors: V
authors: de Jesus Perez
authors: Mehdi
authors: M
authors: Skhiri
authors: Randall
authors: R
authors: Vagelos
authors: Ingela
authors: I
authors: Schnittger
authors: Andre Y
authors: AY
authors: Denault
authors: David N
authors: DN
authors: Rosenthal
authors: Ramona L
authors: RL
authors: Doyle
authors: Roham T
authors: RT
authors: Zamanian
mesh_terms: D000208:Acute Disease; D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D015656:Respiratory Mechanics / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D012964:Sodium / Q000097:blood; D015996:Survival Rate
chemical_list: D012964:Sodium