Echocardiographic assessment of pulmonary artery systolic pressure and outcomes in ambulatory heart failure patients.
BACKGROUND
Pulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed.


RESULTS
We examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54 ± 13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range [IQR]: 29, 46). After a median follow-up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10-mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥ 48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk.


CONCLUSIONS
Elevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events.
Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University, Atlanta, GA.
Andreas P
AP
Kalogeropoulos
Sarawut
S
Siwamogsatham
Salim
S
Hayek
Song
S
Li
Anjan
A
Deka
Catherine N
CN
Marti
Vasiliki V
VV
Georgiopoulou
Javed
J
Butler
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D062186:Arterial Pressure; D016280:Atrial Function, Right; D062185:Atrial Pressure; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
echocardiography; heart failure; mortality; outcomes; pulmonary hypertension