title: The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease.
abstract: OBJECTIVE
  This study sought to evaluate if diastolic pulmonary gradient (DPG) can predict survival in patients with pulmonary hypertension due to left heart disease (PH-LHD).
  
  
  BACKGROUND
  Patients with combined post- and pre-capillary PH-LHD have worse prognosis than those with passive pulmonary hypertension. The transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) have commonly been used to identify high-risk patients. However, these parameters have significant shortcomings and do not always correlate with pulmonary vasculature remodeling. Recently, it has been suggested that DPG may be better a marker, yet its prognostic ability in patients with cardiomyopathy has not been fully assessed.
  
  
  METHODS
  A retrospective cohort of 1,236 patients evaluated for unexplained cardiomyopathy at Johns Hopkins Hospital was studied. All patients underwent right heart catheterization and were followed until death, cardiac transplantation, or the end of the study period (mean time 4.4 years). The relationships between DPG, TPG, or PVR and survival in subjects with PH-LHD (n = 469) were evaluated with Cox proportional hazards regression and Kaplan-Meier analyses.
  
  
  RESULTS
  DPG was not significantly associated with mortality (hazard ratio [HR]: 1.02, p = 0.10) in PH-LHD whereas elevated TPG and PVR predicted death (HR: 1.02, p = 0.046; and HR: 1.11, p = 0.002, respectively). Similarly, DPG did not differentiate survivors from non-survivors at any selected cut points including a DPG of 7 mm Hg.
  
  
  CONCLUSIONS
  In this retrospective study of patients with cardiomyopathy and PH-LHD, an elevated DPG was not associated with worse survival.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Tampakakis
authors.affiliation: Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Leary
authors.affiliation: Division of Cardiology, University of California-San Francisco, San Francisco, California.
authors.forename: Van N
authors.initials: VN
authors.lastname: Selby
authors.affiliation: Division of Cardiology, University of California-San Francisco, San Francisco, California.
authors.forename: Teresa
authors.initials: T
authors.lastname: De Marco
authors.affiliation: Penn Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cappola
authors.affiliation: Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Kasper
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address: ryan.tedford@jhmi.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Tedford
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014655:Vascular Resistance / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000503:physiopathology
keywords: diastolic pulmonary gradient; left heart disease; pulmonary hypertension; survival