Increased Speckle Tracking Carotid Artery Strain in Patients Treated With Statin or Anti-Platelet Therapy

Abstract

on the specific causes of death for such patients. Of particular concern in the management of PH patients is the risk of sudden cardiac death. This study was designed to gain a better understanding of the causes of death among patients with all types of PH and to determine which characteristics were most associated with prognosis. METHODS: A retrospective study of PH patients with PH who died between 2008 and 2014. Demographics, lab values, test results, and causes of death were compared. Causes of death were categorized by cardiopulmonary causes and noncardiopulmonary causes for comparison. RESULTS: Among the 78 deceased patients, 48 (61.5%) were female and the average age at death was 72.6 AE 14.5 years. The distribution of patients diagnosed with PH group I, II, III, and IV was 34 (43.6%), 29 (37.2%) 13 (16.7%), and 2 (2.6%), respectively. The three most common causes of death overall were heart failure (24.4%), pneumonia (16.7%), and respiratory failure (14.1%). Cardiopulmonary causes accounted for 58 (74.4%) deaths and non-cardiopulmonary causes accounted for 20 (25.6%) deaths. The three most common non-cardiopulmonary causes of death were sepsis (6.4%), stroke (5.1%), and cancer (5.1%). The highest proportion of non-cardiopulmonary deaths occurred during the first 3 months following diagnosis. Whether patients died from cardiopulmonary or non-cardiopulmonary causes did not affect their time from diagnosis to death (2.2 AE 2 vs 2.1 AE 2.1 years; P ¼ .800). Patients who died from cardiopulmonary causes had a lower left ventricular mass, DLCO, diastolic RVP, and mean PCWP. On right heart catheterization (RHC), higher systolic pulmonary arterial pressures, transpulmonary gradients, and diastolic pulmonary gradients were risk factors for earlier death. Higher serum potassium and lower serum creatinine levels were also risk factors for earlier death. Sudden cardiac death was the fourth most common cause of death overall and occurred in 6 (7.7%) patients, 4 of which had group 1 pulmonary arterial hypertension (PAH). Patients in the sudden cardiac death group died at younger ages than those who died of other causes (61.8 AE 8.1 vs 73.5 AE 13.7 years; P ¼ .057). CONCLUSION: Most PH patients died from cardiopulmonary causes and patients were most at-risk for death from noncardiopulmonary causes in the early months following PH diagnosis. Catheterization and serum analysis may yield important prognostic indicators among PH patients.