Pulmonary hypertension predicts all‐cause mortality in patients with heart failure: a retrospective cohort study

Abstract

AimsThe presence of pulmonary hypertension (PH) in left ventricular systolic dysfunction (LVSD) and symptomatic heart failure is an ominous sign. There are insufficient data regarding the risk conferred by increasing severity of PH in patients with heart failure. Methods and resultsWe performed a record linkage study in Tayside, Scotland (population 400 000) utilizing the Tayside echocardiogram database (.50 000 echocardiograms) maintained by the Health Informatics Centre (HIC). Data sets from the HIC include mortality data, cardiovascular medications, and other healthcare activities linked anonymously by the community health index (CHI) number. Patients were included in the analysis if they had LVSD, had a valid right ventricular systolic pressure (RVSP) measurement, and had a loop diuretic prescription (provided not more than 1 year prior to echocardiogram). A Cox proportional hazard model was used to examine the effects of RVSP on all-cause mortality. A total of 1612 patients [mean age, 75.2 + 10.9 (SD) years; 57.4% male] met the entry criteria. Mean RVSP for the cohort was 44.9 + 13.1 mmHg and mean follow-up was 2.8 + 2.5 years. For each 5 mmHg stepwise increase in RVSP, after adjustment for confounding factors including the degree of LVSD and the presence of chronic obstructive pulmonary disease, the hazard ratio (HR) for all-cause mortality was 1.06 (1.03-1.08, P , 0.001). ConclusionsPulmonary hypertension predicted all-cause mortality in a heterogeneous group of patients with heart failure. Each 5 mmHg rise in RVSP was associated with a 6% increased risk of death.--

Quantitative Doppler-Echocardiographic Imaging and Clinical Outcomes With Left Ventricular Systolic Dysfunction

“…18 By quantifying the FMR, which is poorly assessed by standard qualitative methods, we ensured that through the matching process patients with and without PH had similar degrees of FMR so that we could ascertain for the first time that the PH link to morality is not a surrogate for FMR. Furthermore, our subgroup analysis, which could not be performed in previous studies because of lack of FMR ascertainment, [7][8][9]33 shows that PH is equally predictive of excess mortality with or without FMR, confirming the independent role of PH in predicting survival. Similarly, although an independent link between LVDD and mortality is not entirely established, by obtaining quantitative measures of LVDD, we were also able for the first time to demonstrate that PH is not a surrogate of LVDD.…”

Cardiovascular and Mortality Outcomes in the Elderly With Impaired Cardiac and Pulmonary Function: The Cardiovascular Health Study (CHS)

“…However, pulmonary hypertension is possibly an important comorbidity, which can result from LVSD32, 33, 34 or IPF 35, 36. Whether due to LVSD37, 38 or IPF,39, 40, 41 pulmonary hypertension is associated with significantly increased morbidity and mortality. In addition to the postulated role of pulmonary hypertension, there is evidence demonstrating extensive redistribution of pulmonary blood flow in individuals with hemodynamically significant LVSD, underscoring a complex heart–lung interaction 42.…”

Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon

“…[7,8] PH is a disease with devastating effects on quality of life and life expectancy, and is a potent cause of heart failure (HF) in general. [7,[9][10][11][12] Indeed, one autopsy study from South Africa identified PH as one of the commonest causes of death, accounting for RESEARCH 31% of all cardiovascular deaths. [13] The Pan African Pulmonary Hypertension Cohort (PAPUCO) study was established to investigate the epidemiology, causes and natural history of PH in Africa.…”