title: Elevated pulmonary artery systolic pressure predicts heart failure admissions in African Americans: Jackson Heart Study.
abstract: BACKGROUND
  Although elevated pulmonary artery systolic pressure (PASP) is associated with heart failure (HF), whether PASP measurement can help predict future HF admissions is not known, especially in African Americans who are at increased risk for HF. We hypothesized that elevated PASP is associated with increased risk of HF admission and improves HF prediction in African American population.
  
  
  RESULTS
  We conducted a longitudinal analysis using the Jackson Heart Study cohort (n=3125; 32.2% men) with baseline echocardiography-derived PASP and follow-up for HF admissions. Hazard ratio for HF admission was estimated using Cox proportional hazard model adjusted for variables in the Atherosclerosis Risk in Community (ARIC) HF prediction model. During a median follow-up of 3.46 years, 3.42% of the cohort was admitted for HF. Subjects with HF had a higher PASP (35.6±11.4 versus 27.6±6.9 mm Hg; P<0.001). The hazard of HF admission increased with higher baseline PASP (adjusted hazard ratio per 10 mm Hg increase in PASP: 2.03; 95% confidence interval, 1.67-2.48; adjusted hazard ratio for highest [≥33 mm Hg] versus lowest quartile [<24 mm Hg] of PASP: 2.69; 95% confidence interval, 1.43-5.06) and remained significant irrespective of history of HF or preserved/reduced ejection fraction. Addition of PASP to the ARIC model resulted in a significant improvement in model discrimination (area under the curve=0.82 before versus 0.84 after; P=0.03) and improved net reclassification index (11-15%) using PASP as a continuous or dichotomous (cutoff=33 mm Hg) variable.
  
  
  CONCLUSIONS
  Elevated PASP predicts HF admissions in African Americans and may aid in early identification of at-risk subjects for aggressive risk factor modification.
authors.affiliation: From the Vascular Research Laboratory, Providence VA Medical Center, RI (G.C., M.J., W.-C.W.); and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C., M.J., W.-C.W.). Gaurav_choudhary@brown.edu.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.affiliation: From the Vascular Research Laboratory, Providence VA Medical Center, RI (G.C., M.J., W.-C.W.); and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C., M.J., W.-C.W.).
authors.forename: Matthew
authors.initials: M
authors.lastname: Jankowich
authors.affiliation: From the Vascular Research Laboratory, Providence VA Medical Center, RI (G.C., M.J., W.-C.W.); and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C., M.J., W.-C.W.).
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000208:ethnology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: African Americans; heart failure; hypertension, pulmonary