Usefulness of noninvasive estimate of pulmonary vascular resistance to predict mortality, heart failure, and adverse cardiovascular events in patients with stable coronary artery disease (from the heart and soul study)

被引:32
作者
Farzaneh-Far, Ramin [1 ]
Na, Beeya [2 ]
Whooley, Mary A. [1 ,2 ]
Schiller, Nelson B. [1 ]
机构
[1] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
[2] Vet Affairs Med Ctr, San Francisco, CA 94121 USA
关键词
D O I
10.1016/j.amjcard.2007.11.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pulmonary vascular resistance (PVR) is an important hemodynamic variable that affects prognosis and therapy in a wide range of cardiovascular and pulmonary conditions. We sought to determine whether a noninvasive estimate of PVR predicts adverse outcomes in patients with stable coronary artery disease. Using Doppler echocardiography we measured the estimated PVR (defined as the ratio of the tricuspid regurgitant velocity [TRV] to the velocity-time integral [VTI] of the right ventricular outflow tract [RVOT]) in 795 ambulatory patients with stable coronary artery disease. Participants were categorized by quartiles of the TRV/VTIRVOT ratio. Hazard ratios (HRs) and 95% confidence intervals were calculated for all-cause mortality, heart failure hospitalization, and adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or stroke). After 4.3 years of follow-up there were 161 deaths, 44 deaths from cardiovascular causes, 103 heart failure hospitalizations, and 120 adverse cardiovascular events. Compared with patients in the lowest TRV/VTIRVOT quartile, those in the highest quartile were at increased risk of all-cause mortality (unadjusted HR 1.8, 95% confidence interval 1.3 to 2.5), heart failure hospitalization (unadjusted HR 2.9, 95% confidence interval 2.0 to 4.3), and adverse cardiovascular events (unadjusted HR 2.0, 95% confidence interval 1.4 to 2.9). After multivariate adjustment, patients in the highest quartile were at increased risk of heart failure hospitalizations (adjusted FIR 2.5, 95% confidence interval 1.3 to 4.7). In conclusion, a noninvasive estimate of PVR (TRV/VTIRVOT ratio) predicts mortality, heart failure hospitalization, and adverse cardiovascular events in patients with stable coronary artery disease. (C) 2008 Elsevier Inc. All rights reserved.
引用
收藏
页码:762 / 766
页数:5
相关论文
共 10 条
[1]   A simple method for noninvasive estimation of pulmonary vascular resistance [J].
Abbas, AE ;
Fortuin, FD ;
Schiller, NB ;
Appleton, CP ;
Moreno, CA ;
Lester, SJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (06) :1021-1027
[2]   Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease [J].
Arcasoy, SM ;
Christie, JD ;
Ferrari, VA ;
Sutton, MS ;
Zisman, DA ;
Blumenthal, NP ;
Pochettino, A ;
Kotloff, RM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2003, 167 (05) :735-740
[3]   Mechanisms of disease: Pulmonary arterial hypertension [J].
Farber, HW ;
Loscalzo, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (16) :1655-1665
[4]   Hemodynamic and exercise effects of phosphodiesterase 5 inhibitors [J].
Jackson, G .
AMERICAN JOURNAL OF CARDIOLOGY, 2005, 96 (12B) :32M-36M
[5]   NONINVASIVE ESTIMATION OF RIGHT ATRIAL PRESSURE FROM THE INSPIRATORY COLLAPSE OF THE INFERIOR VENA-CAVA [J].
KIRCHER, BJ ;
HIMELMAN, RB ;
SCHILLER, NB .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 66 (04) :493-496
[6]   Pulmonary arterial hypertension [J].
McLaughlin, Vallerie V. ;
McGoon, Michael D. .
CIRCULATION, 2006, 114 (13) :1417-1431
[7]   Pulmonary regurgitation end-diastolic gradient is a Doppler marker of cardiac status: Data from the heart and soul study [J].
Ristow, B ;
Ahmed, S ;
Wang, LY ;
Liu, HY ;
Angeja, BG ;
Whooley, MA ;
Schiller, NB .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2005, 18 (09) :885-891
[8]   Elevated pulmonary artery pressure by doppler echocardiography predicts hospitalization for heart failure and mortality in ambulatory stable coronary artery disease - The Heart and Soul Study [J].
Ristow, Bryan ;
Ali, Sadia ;
Ren, Xiushui ;
Whooley, Mary A. ;
Schiller, Nelson B. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (01) :43-49
[9]   Depressive symptoms and health-related quality of life - The heart and soul study [J].
Ruo, B ;
Rumsfeld, JS ;
Hlatky, MA ;
Liu, HY ;
Browner, WS ;
Whooley, MA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 290 (02) :215-221
[10]   NONINVASIVE ESTIMATION OF RIGHT VENTRICULAR SYSTOLIC PRESSURE BY DOPPLER ULTRASOUND IN PATIENTS WITH TRICUSPID REGURGITATION [J].
YOCK, PG ;
POPP, RL .
CIRCULATION, 1984, 70 (04) :657-662