title: The impact of pulmonary hypertension on outcomes of patients with low left ventricular ejection fraction: a propensity analysis.
abstract: OBJECTIVE
  Pulmonary hypertension (PH) is commonly described as a risk factor in cardiac surgery; however, the effect of a low left ventricular ejection fraction (LVEF) on PH has not been assessed. Hence, the study aim was to determine whether PH increases operative mortality and survival outcome in patients with a low LVEF.
  
  
  METHODS
  Between January 2001 and September 2009, a total of 845 consecutive patients with LVEF < 40% was enrolled into the study. Among these patients, 444 had a pulmonary pressure < 40 mmHg (NPH group), while in 401 patients the pulmonary pressure was > or = 40 mmHg.
  
  
  RESULTS
  Preoperatively, the PH patients were older (p < 0.001), had a lower LVEF (p = 0.001), and had a higher logistic EuroSCORE (p < 0.001) and serum creatinine level (p < 0.026) when compared to NPH patients. The PH patients showed a greater tendency to develop postoperative complications (p < 0.001). After adjusting by propensity score, the in-hospital mortality was significantly higher among PH patients (p < 0.001), while multivariate logistic regressions revealed PH as an independent predictor for in-hospital mortality (p = 0.036). The 12-, 36-, and 60-month follow up mortality rates were significantly higher in the PH group. By using a Cox logistic regression model, PH was shown to be an independent predictor for follow up mortality (p = 0.035).
  
  
  CONCLUSIONS
  Pulmonary hypertension increased the morbidity and mortality in patients with a low LVEF who were undergoing cardiac surgery. Future studies may identify subgroups that may benefit from a preoperative optimization of PH and/or intra- and postoperative therapies directed at minimizing the effects of the condition.
authors: Cardiovascular Surgery Department of Qilu Hospital of Shandong University, Jinan, China. xycyang@hotmail.com
authors: Changyong
authors: C
authors: Yang
authors: Dadong
authors: D
authors: Li
authors: Roger
authors: R
authors: Mennett
authors: Jonathan
authors: J
authors: Hammond
authors: Gong
authors: G
authors: Zhang
authors: Donghui
authors: D
authors: Chen
authors: Justin
authors: J
authors: Lundbye
authors: Robert
authors: R
authors: Gallagher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D003237:Connecticut; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left