Prevalence and Clinical Characteristics Associated with Pulmonary Hypertension in African-Americans

Choudhary, Gaurav; Jankowich, Matthew; Wu, Wen‐Chih

doi:10.1371/journal.pone.0084264

Cited by 40 publications

(55 citation statements)

References 37 publications

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“…7,14,24–27 While an increase in mortality and heart failure hospitalizations has been reported in large population cohort studies at PA systolic pressure below abnormal when assessed echocardiographically, 9,12,28 considering the limited precision of this method for determining cardiopulmonary hemodynamics 13,29 and the requirement of mPAP to diagnose PH, the clinical relevance of these findings remained unclear. Our study confirms the relationship between mPAP and outcomes in a medically complex patient cohort using the gold-standard method of diagnosis, invasive hemodynamic monitoring, in a large national sample.…”

Section: Discussionmentioning

confidence: 99%

Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

et al. 2016

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Background Pulmonary hypertension (PH) is associated with increased morbidity across the cardiopulmonary disease spectrum. Based largely on expert consensus opinion, PH is defined by a mean pulmonary artery pressure (mPAP) ≥25 mmHg. Although mPAP levels below this threshold are common among populations at risk for PH, the relevance of mPAP <25 mmHg to clinical outcome is unknown. Methods and Results We analyzed retrospectively all US veterans undergoing right heart catheterization (RHC)(2007–2012) in the Veterans Affairs health care system (N=21,727; 908 day median follow-up). Cox proportional hazards models were used to evaluate the association between mPAP and outcomes of all-cause mortality and hospitalization, adjusted for clinical covariates. When treating mPAP as a continuous variable, the mortality hazard increased beginning at 19 mmHg (HR=1.183, 95% CI [1.004–1.393]) relative to 10 mmHg. Therefore, patients were stratified into three groups: referent (≤18 mmHg; N=4,207), borderline PH (19–24 mmHg; N=5,030), and PH (≥25 mmHg; N=12,490). The adjusted mortality hazard was increased for borderline PH (HR=1.23, 95% CI [1.12–1.36], P<0.0001) and PH (HR=2.16, 95% CI [1.96–2.38], P<0.0001) compared to the referent group. The adjusted hazard for hospitalization was also increased in borderline PH (HR=1.07, 95% CI [1.01–1.12], P=0.0149) and PH (HR=1.15, 95% CI [1.09–1.22], P<0.0001). The borderline PH cohort remained at increased risk for mortality after excluding the following high-risk subgroups: patients with pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance ≥3.0 Wood units, or inpatient status at the time of RHC. Conclusions These data illustrate a continuum of risk according to mPAP level, and that borderline PH is associated with increased mortality and hospitalization. Future investigations are needed to test the generalizability of our findings to other populations and study the effect of treatment on outcome in borderline PH.

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Section: Discussionmentioning

confidence: 99%

Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

et al. 2016

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“…While screening asymptomatic patients is not recommended, Doppler echocardiography is frequently used in assessment of patients with cardiovascular co-morbidities. Pulmonary artery systolic pressures are easily obtained in about two-thirds of patients undergoing echocardiograms 4, 9 . Our data suggests that PASP can be used to identify patients that are at risk for subsequent HF admission, especially in patients with preserved EF.…”

Section: Discussionmentioning

confidence: 99%

“…In the AA population, elevated PASP is independently associated with co-morbidities that increase the risk of HF such as obesity, diabetes and hypertension 9 . Furthermore, left atrial hypertension due to cardiac dysfunction commonly results in elevation of PASP.…”

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Elevated Pulmonary Artery Systolic Pressure Predicts Heart Failure Admissions in African Americans

Choudhary

Jankowich

2014

Circ: Heart Failure

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Background While elevated pulmonary artery systolic pressure (PASP) is associated with heart failure (HF), whether PASP measurement can help predict future HF admissions is not known, especially in African-Americans, who are at increased risk for HF. We hypothesized that elevated PASP is associated with increased risk of HF admission and improves HF prediction in African-American (AA) population. Methods and Results We conducted a longitudinal analysis using the JHS cohort (n=3125, 32.2% men) with baseline echo-derived PASP and follow-up for HF admissions. Hazard ratio for HF admission was estimated using Cox-proportional hazard model adjusted for variables in the Atherosclerosis Risk in Community (ARIC) HF prediction model. Over median follow up of 3.46 years, 3.42% of the cohort was admitted for HF. Subjects with HF had a higher PASP (35.6 ± 11.4 mm Hg vs. 27.6 ± 6.9 mm Hg, p<0.001). The hazard of HF admission increased with higher baseline PASP (adjusted HR/10 mmHg increase in PASP: 2.03, 95% CI: 1.67-2.48; adjusted HR for highest (≥33 mmHg) versus lowest quartile (<24 mmHg) of PASP: 2.69, 95% CI: 1.43-5.06) and remained significant irrespective of history of HF, or preserved/reduced ejection fraction. Addition of PASP to the ARIC model resulted in a significant improvement in model discrimination (AUC = 0.82 before vs. 0.84 after, p = 0.03), and improved net reclassification index (11-15%), using PASP as a continuous or dichotomous (cutoff: 33 mm Hg) variable. Conclusions Elevated PASP predict HF admissions in African Americans and may aid in early identification of at risk subjects for aggressive risk factor modification.

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“…The second model included all covariates listed in the above section: age, sex, body mass index category, pulse pressure, hypertension, diabetes, coronary heart disease, history of chronic lung disease, spirometry profile and ejection fraction. The second model was adapted from a model of pulmonary hypertension adapted from Choudhary et al [12]. The adaptation in this model from the originally published model was the inclusion of an ejection fraction less than 50%.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary hypertension is also prevalent in African-Americans and is more prevalent in African-American females than males [12]. Given that African-Americans are at risk for both iron deficiency and pulmonary hypertension, and that these two conditions may be linked pathogenetically, we therefore set out to determine if iron deficiency was associated with pulmonary hypertension.…”

Section: Introductionmentioning

confidence: 99%

Relationship of Iron Deficiency and Serum Ferritin Levels With Pulmonary Hypertension: The Jackson Heart Study

Jankowich

Evans

Elston

et al. 2016

Chest

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Prevalence and Clinical Characteristics Associated with Pulmonary Hypertension in African-Americans

Cited by 40 publications

References 37 publications

Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

Elevated Pulmonary Artery Systolic Pressure Predicts Heart Failure Admissions in African Americans

Relationship of Iron Deficiency and Serum Ferritin Levels With Pulmonary Hypertension: The Jackson Heart Study

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