title: Prevalence, Determinants, and Prognostic Significance of Pulmonary Hypertension in Elderly Patients Admitted with Acute Decompensated Heart Failure: A Report from the BIO-HF Registry.
abstract: OBJECTIVE
  Pulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear.
  
  
  METHODS
  We prospectively evaluated 401 patients aged ≥ 75 years (mean age 83 ± 5 years, 50% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient ≥ 30 mmHg. The endpoint was all-cause mortality.
  
  
  RESULTS
  PHT was found in 280/401 patients (69%), including in 67% of patients with HF with reduced ejection fraction (HFrEF) and 73% of patients with HF with preserved ejection fraction (HFpEF) (P = 0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65%; moderate: 67%; severe: 85%; P < 0.01). After a mean follow-up of 405 ± 399 days, 118 patients (30%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.11, P < 0.001), serum creatinine (HR 1.41, 95% CI 1.15-1.73, P < 0.01), and PHT (HR 1.60, 95% CI 1.03-2.49, P < 0.01) were independent predictors of all-cause mortality.
  
  
  CONCLUSIONS
  In elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vanhercke
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Pardaens
authors.affiliation: Department of Cardiology, University Hospital Brussels, Brussels, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Weytjens
authors.affiliation: Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vande Kerckhove
authors.affiliation: Department of Cardiology, University Hospital Brussels, Brussels, Belgium.
authors.forename: Nancy
authors.initials: N
authors.lastname: De Laet
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Emilie
authors.initials: E
authors.lastname: Janssens
authors.affiliation: Department of Cardiology, University Hospital Brussels, Brussels, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Van Camp
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.|Department of Cardiology, AZ Maria Middelares, Ghent, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: De Sutter
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D013318:Stroke Volume; D014463:Ultrasonography
keywords: elderly; heart failure; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; pulmonary hypertension