title: Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure.
abstract: BACKGROUND
  Reduced pulmonary arterial compliance (Ca) is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that pulmonary arterial Ca could be a predictor of outcome in patients with chronic heart failure (CHF).
  
  
  METHODS
  We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right-sided heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end point was cardiovascular death; secondary end point was the composite of cardiovascular death, urgent heart transplantation, and appropriately detected and treated episode of ventricular fibrillation.
  
  
  RESULTS
  An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 s. In patients with pulmonary capillary wedge pressure (PCWP) &lt; 15 mm Hg, the mean RC-time was 0.34 ± 0.14 s, and in patients with PCWP ≥ 15 mm Hg it was 0.28 ± 0.22 s. Eighty-seven patients died in a follow-up period of 50 ± 32 months. At receiver operating characteristic curve analysis, the optimal prognostic cutoff point of SV/PP was 2.15 mL/mm Hg. An elevated (&gt; 2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high (P = .003) and in patients with normal pulmonary vascular resistance (P = .005).
  
  
  CONCLUSIONS
  Pulmonary arterial Ca is a strong prognostic indicator in patients with CHF with sLVD. Most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance.
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pellegrini
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pasotti
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Raineri
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.affiliation: Cardiac, Thoracic, and Vascular Department, University of Pisa, Pisa, Italy.
authors.forename: Frank Lloyd
authors.initials: FL
authors.lastname: Dini
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Temporelli
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.affiliation: Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Vanderpool
authors.affiliation: Department of Physiology, Erasme Campus of the Free University of Brussels, Brussels, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. Electronic address: s.ghio@smatteo.pv.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
mesh_terms: D006328:Cardiac Catheterization; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D014655:Vascular Resistance / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*