Pulmonary Pressures and Death in Heart Failure

Bursi, Francesca; McNallan, Sheila M; Redfield, Margaret M.; Nkomo, Vuyisile T.; Lam, Carolyn S.P.; Weston, Susan A.; Jiang, Ruoxiang; Roger, Véronique L.

doi:10.1016/j.jacc.2011.06.076

Cited by 254 publications

(215 citation statements)

References 43 publications

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“…The true prevalence of PH-LHD in heart failure remains unknown, mostly because the definition of PH in epidemiological studies has been based on echocardiography, with a variety of cut-off values [4,384]. Invasive haemodynamics were reported in a limited number of single-centre reports [4].…”

Section: Pulmonary Hypertension Due To Left Heart Disease (Group 2)mentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

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Section: Pulmonary Hypertension Due To Left Heart Disease (Group 2)mentioning

confidence: 99%

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

et al. 2015

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“…PH and CKD are disease states associated with poor outcomes (13,16,19). In this large cohort of patients with PH (based on right heart catheterization data), underlying CKD was highly prevalent.…”

Section: Discussionmentioning

confidence: 93%

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.Design, setting, participants, & measurements The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure$25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR,60 ml/min per 1.73 m 2 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.Results Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m 2 lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure. ConclusionIn a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.

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“…30,31 Similar to elevated jugular venous distension, bedside ultrasound examination of the IVC diameter can serve as a rapid and noninvasive measurement of right atrial pressure. 32 Elevated right atrial pressure is most often due to elevated left ventricular filling pressure transmitted via the pulmonary vasculature, but it is important to note that right-and …”

Section: Discussionmentioning

confidence: 99%

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

Cubo-Romano

Torres‐Macho

Soni

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247‐bed urban teaching hospital in Spain PATIENTS Ninety‐seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90‐day all‐cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180‐day all‐cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90‐day follow‐up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90‐day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21‐28.10; P = 0.025) and 90‐day readmission (HR: 3.20; 95% CI: 1.24‐8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90‐day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778–784. © 2016 Society of Hospital Medicine

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Pulmonary Pressures and Death in Heart Failure

Cited by 254 publications

References 43 publications

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

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