title: Echocardiographic estimation of pulmonary arterial systolic pressure in acute heart failure. Prognostic implications.
abstract: BACKGROUND
  Prognostic implications of echocardiographic assessment of pulmonary hypertension (PH) in non-selected patients hospitalized for acute heart failure (AHF) are not clearly defined. The aim of this study was to evaluate the association between echocardiography-derived PH in AHF and 1-year all-cause mortality.
  
  
  METHODS
  We prospectively included 1210 consecutive patients admitted for AHF. Patients with significant heart valve disease were excluded. Pulmonary arterial systolic pressure (PASP) was estimated using transthoracic echocardiography during hospitalization (mean time after admission 96±24h). Patients were categorized as follows: non-measurable, normal PASP (PASP≤35mmHg), mild (PASP 36-45mmHg), moderate (PASP 46-60mmHg) and severe PH (PASP >60mmHg). The independent association between PASP and 1-year mortality was assessed with Cox regression analysis.
  
  
  RESULTS
  At 1-year follow-up, 232 (19.2%) deaths were registered. PASP was measured in 502 (41.6%) patients with a median of 46 [38-55] mmHg. The distribution of population was: 708 (58.5%), 76 (6.3%), 147 (12.1%), 190 (15.7%) and 89 (7.4%) for non-measurable, normal PASP, mild, moderate and severe PH, respectively. One-year mortality was lower for patients with normal PASP (1.32 per 10 person-years), intermediate for patients with non-measurable, mild and moderate PH (2.48, 2.46 and 2.62 per 10 persons-year, respectively) and higher for those with severe PH (4.89 per 10 person-years). After multivariate adjustment, only patients with PASP >60mmHg displayed significant adjusted increase in the risk of 1-year all-cause mortality, compared to patients with normal PASP (HR=2.56; CI 95%: 1.05-6.22, p=0.038).
  
  
  CONCLUSIONS
  In AHF, severe pulmonary hypertension derived by echocardiography is an independent predictor of 1-year-mortality.
authors.affiliation: Cardiology Department, Hospital Clínico Universitario Valencia, Blasco Ibanez, 17, Valencia 46010, Spain. pilarmerlos@gmail.com
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodí
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.forename: Lourdes
authors.initials: L
authors.lastname: Bondanza
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013599:Systole
keywords: AHF; Acute heart failure; CI; Confidence interval; HF; HR; Hazard ratio; Heart failure; IQR; Interquartile range; LVEF; Left ventricular ejection fraction; PASP; PH; Prognosis; Pulmonary arterial systolic pressure; Pulmonary hypertension