Prognostic Effect and Longitudinal Hemodynamic Assessment of Borderline Pulmonary Hypertension

Assad, Tufik R.; Maron, Bradley A.; Robbins, Ivan M.; Xu, Meng; Huang, Shi; Harrell, Frank E.; Farber‐Eger, Eric; Wells, Quinn S.; Choudhary, Gaurav; Hemnes, Anna R.; Brittain, Evan L.

doi:10.1001/jamacardio.2017.3882

Cited by 144 publications

(107 citation statements)

References 34 publications

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“…Forty full‐text articles were assessed for eligibility (Figure 1). Fifteen (8 RHC and 7 echocardiography) studies were included in the meta‐analysis 2, 3, 4, 5, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20. The characteristics of the included studies are shown in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Studies included in this analysis are Valerio et al,10 Heresi et al,11 Kovacs et al,5 Suzuki et al,12 Maron et al,3 Takahashi et al,13 Douschan et al,4 Assad et al,2 Abramson et al,14 Kjaergaard et al,15 Shalaby et al,16 Lam et al,17 Damy et al,18 Cabrita et al,19 and Choudhary et al 20. CI indicates confidence interval; M‐H, Mantel‐Haenszel; RHC, right heart catheterization.…”

Section: Resultsmentioning

confidence: 99%

“…Studies included in this analysis are Heresi et al,11 Suzuki et al,12 Maron et al,3 Takahashi et al,13 Assad et al,2 Shalaby et al,16 Cabrita et al,19 and Choudhary et al 20. CI indicates confidence interval; PH, pulmonary hypertension; IV, Inverse Variance; RHC, right heart catheterization.…”

Section: Resultsmentioning

confidence: 99%

“…Findings from 2 large right heart catheterization (RHC) registries2, 3 and numerous other smaller clinical studies4, 5 have demonstrated that mPAP of >19 mm Hg (previously termed “borderline pulmonary hypertension [PH]”) is an independent risk factor for increased mortality. This observation indicates that the traditional mPAP threshold for defining PH of ≥25 mm Hg may be insufficient.…”

Section: Introductionmentioning

confidence: 99%

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Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Kolte

Lakshmanan

Jankowich

et al. 2018

JAHA

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105

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BackgroundRecent studies have demonstrated a continuum in clinical risk related to mean pulmonary artery pressure that begins at >19 mm Hg, which is below the traditional threshold used to define pulmonary hypertension (PH) of 25 mm Hg. Because of the implications on patient diagnosis and prognosis, the generalizability and validity of these data need further confirmation.Methods and ResultsDatabases were searched from inception through January 31, 2018, to identify studies comparing all‐cause mortality between patients with mildly elevated mean pulmonary artery pressure near but <25 mm Hg versus the referent group. The meta‐analysis included 15 nonrandomized studies and 16 482 patients (7451 [45.2%] with measured or calculated mean pulmonary artery pressure of 19–24 mm Hg by right heart catheterization [n=6037] and echocardiography [n=1414] [mild PH]). The mean duration of follow‐up was 5.2 years. Compared with the referent group, mild PH was associated with an increased risk of mortality (risk ratio, 1.52; 95% confidence interval, 1.32–1.74; P<0.001; I2=47%). Secondary analysis using risk‐adjusted time‐to‐event estimates showed a similar result (hazard ratio, 1.19; 95% confidence interval, 1.09–1.31; P<0.001; I2=42%). The findings were consistent between subgroups of right heart catheterization and echocardiography studies (P interaction>0.05). There was evidence of publication bias; however, this did not influence the risk estimate (Duval and Tweedie's trim and fill adjusted risk ratio, 1.34; 95% confidence interval, 1.15–1.56).ConclusionsThe risk of mortality is increased in patients with mild PH, defined as measured or calculated mean pulmonary artery pressure >19 mm Hg. These data emphasize a need for diagnosing patients with mild PH with consideration to enrollment in PH clinical studies investigating pharmacological and nonpharmacological interventions to attenuate clinical risk and improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Kolte

Lakshmanan

Jankowich

et al. 2018

JAHA

Self Cite

105

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“…However, 20% of subjects without a TRV had a mPAP >35 mm Hg, which would have remained undetected had they not also been referred for RHC. Moreover, detecting even mild elevations in pulmonary pressure is important based on recent reports showing that “borderline” values of mean pulmonary pressure are reproducibly associated with increased adjusted mortality 14, 15. Additionally, the no‐TRV group may be earlier in the disease process relative to the TRV group and may in fact develop more readily measurable TRV Doppler signals over time.…”

Section: Discussionmentioning

confidence: 99%

Lack of a Tricuspid Regurgitation Doppler Signal and Pulmonary Hypertension by Invasive Measurement

O'Leary

Assad

et al. 2018

JAHA

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BackgroundTransthoracic echocardiography (TTE) is used to estimate pulmonary artery systolic pressure, but an adequate tricuspid regurgitation velocity (TRV) needed to calculate pulmonary artery systolic pressure is not always present. It is unknown whether the absence of a measurable TRV signifies normal pulmonary artery pressure.Methods and ResultsWe extracted hemodynamic, TTE, and clinical data from Vanderbilt's deidentified electronic medical record in all patients referred for right heart catheterization between 1998 and 2014. Pulmonary hypertension (PH) was defined as mean pulmonary artery pressure ≥25 mm Hg. We examined the prevalence and clinical correlates of PH in patients without a reported TRV. We identified 1262 patients with a TTE within 2 days of right heart catheterization. In total, 803/1262 (64%) had a reported TRV, whereas 459 (36%) had no reported TRV. Invasively confirmed PH was present in 47% of patients without a reported TRV versus 68% in those with a reported TRV (P<0.001). Absence of a TRV yielded a negative predictive value for excluding PH of 53%. Right ventricular dysfunction, left atrial dimension, elevated body mass index, higher brain natriuretic peptide, diabetes mellitus, and heart failure were independently associated with PH among patients without a reported TRV.Conclusions PH is present in almost half of patients without a measurable TRV who are referred for both TTE and right heart catheterization. Clinical and echocardiographic features of left heart disease are associated with invasively confirmed PH in subjects without a reported TRV. Clinicians should use caution when making assumptions about PH status in the absence of a measurable TRV on TTE.

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Association of Mild Echocardiographic Pulmonary Hypertension With Mortality and Right Ventricular Function

et al. 2019

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Prognostic Effect and Longitudinal Hemodynamic Assessment of Borderline Pulmonary Hypertension

Cited by 144 publications

References 34 publications

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta‐Analysis

Lack of a Tricuspid Regurgitation Doppler Signal and Pulmonary Hypertension by Invasive Measurement

Association of Mild Echocardiographic Pulmonary Hypertension With Mortality and Right Ventricular Function

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