Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure
被引:135
作者:
Damy, Thibaud
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机构:
Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
AP HP, Grp Henri Mondor Albert Chenevier, F-94010 Creteil, France
INSERM, U955, F-94010 Creteil, France
Univ Paris Est 12, Fac Med, UMR S 9555, F-94010 Creteil, FranceUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Damy, Thibaud
[1
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Goode, Kevin M.
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机构:
Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Goode, Kevin M.
[1
]
Kallvikbacka-Bennett, Anna
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机构:
Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Kallvikbacka-Bennett, Anna
[1
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Lewinter, Christian
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Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Lewinter, Christian
[1
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Hobkirk, James
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Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Hobkirk, James
[1
]
Nikitin, Nikolay P.
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Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Nikitin, Nikolay P.
[1
]
Dubois-Rande, Jean-Luc
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h-index: 0
机构:
AP HP, Grp Henri Mondor Albert Chenevier, F-94010 Creteil, France
INSERM, U955, F-94010 Creteil, France
Univ Paris Est 12, Fac Med, UMR S 9555, F-94010 Creteil, FranceUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Dubois-Rande, Jean-Luc
[2
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,4
]
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机构:
Hittinger, Luc
[2
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]
Clark, Andrew L.
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机构:
Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Clark, Andrew L.
[1
]
Cleland, John G. F.
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Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, EnglandUniv Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
Cleland, John G. F.
[1
]
机构:
[1] Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
[2] AP HP, Grp Henri Mondor Albert Chenevier, F-94010 Creteil, France
[3] INSERM, U955, F-94010 Creteil, France
[4] Univ Paris Est 12, Fac Med, UMR S 9555, F-94010 Creteil, France
The epidemiology of pulmonary arterial hypertension (PAH) in patients with heart failure (HF) is poorly described. Our aim was to investigate the determinants and prognostic significance of PAH in a large representative outpatient population with HF. Routine measurement of right ventricular tricuspid pressure gradient (RVTG) was attempted among unselected, consecutive referrals to an HF clinic. The diagnosis of HF was based on symptoms, signs, echocardiography, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Of 2100 patients referred, 1380 were diagnosed as HF, of whom 1026 had left ventricular systolic dysfunction (LVSD) and 354 did not. Right ventricular tricuspid pressure gradient could be measured in 270 (26%) patients with and 143 (40%) without LVSD. The highest RVTG quartile [RVTG > 35 mmHg equivalent to an estimated PA systolic pressure (PASP) > 45 mmHg] constituted 7% of all those with HF and was associated with higher LV filling pressures, LV end-diastolic volume, LVSD, and more severe mitral regurgitation (MR). During a median (inter-quartile range) follow-up of 66 (56-74) months, mortality was 40.3%. Mortality was similar in the lowest quartile of RVTG and in those in whom RVTG could not be measured and rose with increasing RVTG quartile (log-rank: 26.9; P < 0.0001). The highest RVTG quartile, age, blood pressure, and log NT-proBNP independently predicted mortality. Right ventricular tricuspid pressure gradient > 35 mmHg had a 96% specificity to discriminate between those with and without HF in patients without LVSD. Using a definition of PASP > 45 mmHg, 7% of the patients with HF have PAH, which is associated with worse LV function, MR, and prognosis. Whether PAH is a target for therapy in this population remains to be elucidated.
机构:
Univ Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Univ Colorado, Hlth Sci Ctr, Div Cardiol, Denver, CO 80262 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Badesch, David B.
;
Champion, Hunter C.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Div Cardiol, Baltimore, MD USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Champion, Hunter C.
;
Gomez Sanchez, Miguel Angel
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h-index: 0
机构:
Hosp Univ Doce de Octubre, Heart Failure & Pulm Hypertens Unit, Madrid, SpainUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Gomez Sanchez, Miguel Angel
;
Hoeper, Marius M.
论文数: 0引用数: 0
h-index: 0
机构:
Leibniz Univ Hannover, Sch Med, Dept Resp Med, Hannover, GermanyUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Hoeper, Marius M.
;
Loyd, James E.
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h-index: 0
机构:
Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Loyd, James E.
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Manes, Alessandra
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h-index: 0
机构:
Univ Bologna, Inst Cardiol, Bologna, ItalyUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Manes, Alessandra
;
McGoon, Michael
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h-index: 0
机构:
Mayo Clin, Coll Med, Rochester, MN USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
McGoon, Michael
;
Naeije, Robert
论文数: 0引用数: 0
h-index: 0
机构:
Free Univ Brussels, Dept Pathophysiol, Erasme Acad Hosp, Brussels, Belgium
Free Univ Brussels, Dept Cardiol, Erasme Acad Hosp, Brussels, BelgiumUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Naeije, Robert
;
Olschewski, Horst
论文数: 0引用数: 0
h-index: 0
机构:
Med Univ Graz, Univ Clin Internal Med, Pulmonol Div, Graz, AustriaUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Olschewski, Horst
;
Oudiz, Ronald J.
论文数: 0引用数: 0
h-index: 0
机构:
Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Liu Ctr Pulm Hypertens, Torrance, CA 90509 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
机构:
Univ Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Univ Colorado, Hlth Sci Ctr, Div Cardiol, Denver, CO 80262 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Badesch, David B.
;
Champion, Hunter C.
论文数: 0引用数: 0
h-index: 0
机构:
Johns Hopkins Univ, Div Cardiol, Baltimore, MD USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Champion, Hunter C.
;
Gomez Sanchez, Miguel Angel
论文数: 0引用数: 0
h-index: 0
机构:
Hosp Univ Doce de Octubre, Heart Failure & Pulm Hypertens Unit, Madrid, SpainUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Gomez Sanchez, Miguel Angel
;
Hoeper, Marius M.
论文数: 0引用数: 0
h-index: 0
机构:
Leibniz Univ Hannover, Sch Med, Dept Resp Med, Hannover, GermanyUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Hoeper, Marius M.
;
Loyd, James E.
论文数: 0引用数: 0
h-index: 0
机构:
Vanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Loyd, James E.
;
Manes, Alessandra
论文数: 0引用数: 0
h-index: 0
机构:
Univ Bologna, Inst Cardiol, Bologna, ItalyUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Manes, Alessandra
;
McGoon, Michael
论文数: 0引用数: 0
h-index: 0
机构:
Mayo Clin, Coll Med, Rochester, MN USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
McGoon, Michael
;
Naeije, Robert
论文数: 0引用数: 0
h-index: 0
机构:
Free Univ Brussels, Dept Pathophysiol, Erasme Acad Hosp, Brussels, Belgium
Free Univ Brussels, Dept Cardiol, Erasme Acad Hosp, Brussels, BelgiumUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Naeije, Robert
;
Olschewski, Horst
论文数: 0引用数: 0
h-index: 0
机构:
Med Univ Graz, Univ Clin Internal Med, Pulmonol Div, Graz, AustriaUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA
Olschewski, Horst
;
Oudiz, Ronald J.
论文数: 0引用数: 0
h-index: 0
机构:
Harbor UCLA Med Ctr, Los Angeles Biomed Res Inst, Liu Ctr Pulm Hypertens, Torrance, CA 90509 USAUniv Colorado, Hlth Sci Ctr, Div Pulm Sci & Crit Care Med, Denver, CO USA