title: Pulmonary hypertension predicts all-cause mortality in patients with heart failure: a retrospective cohort study.
abstract: OBJECTIVE
  The presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with heart failure.
  
  
  RESULTS
  We performed a record linkage study in Tayside, Scotland (population ∼400,000) utilizing the Tayside echocardiogram database (>50,000 echocardiograms) maintained by the Health Informatics Centre (HIC). Data sets from the HIC include mortality data, cardiovascular medications, and other healthcare activities linked anonymously by the community health index (CHI) number. Patients were included in the analysis if they had LVSD, had a valid right ventricular systolic pressure (RVSP) measurement, and had a loop diuretic prescription (provided not more than 1 year prior to echocardiogram). A Cox proportional hazard model was used to examine the effects of RVSP on all-cause mortality. A total of 1612 patients [mean age, 75.2 ± 10.9 (SD) years; 57.4% male] met the entry criteria. Mean RVSP for the cohort was 44.9 ± 13.1 mmHg and mean follow-up was 2.8 ± 2.5 years. For each 5 mmHg stepwise increase in RVSP, after adjustment for confounding factors including the degree of LVSD and the presence of chronic obstructive pulmonary disease, the hazard ratio (HR) for all-cause mortality was 1.06 (1.03-1.08, P < 0.001).
  
  
  CONCLUSIONS
  Pulmonary hypertension predicted all-cause mortality in a heterogeneous group of patients with heart failure. Each 5 mmHg rise in RVSP was associated with a 6% increased risk of death.
authors.affiliation: Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Szwejkowski
authors.forename: Douglas H J
authors.initials: DH
authors.lastname: Elder
authors.forename: Fiona
authors.initials: F
authors.lastname: Shearer
authors.forename: David
authors.initials: D
authors.lastname: Jack
authors.forename: Anna Maria J
authors.initials: AM
authors.lastname: Choy
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Pringle
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.forename: Jacob
authors.initials: J
authors.lastname: George
authors.forename: Chim C
authors.initials: CC
authors.lastname: Lang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging; D017725:Ventricular Pressure