Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure
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Discussion
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Implication
RVTG measurement may aid HF risk stratification; leaves open whether PAH-targeted interventions improve outcomes.
Key Points
- To determine the epidemiology, clinical determinants, and prognostic significance of pulmonary arterial hypertension in an outpatient cohort with chronic heart failure.
- Prospective evaluation of 2,100 consecutive referrals to a heart failure clinic, identifying 1,380 patients with confirmed heart failure (1,026 with left ventricular systolic dysfunction [LVSD] and 354 without).
- Routine measurement of right ventricular tricuspid pressure gradient (RVTG) was attempted using echocardiography, alongside clinical assessment and NT-proBNP measurement, over a median follow-up of 66 months (interquartile range: 56–74 months).
- The highest RVTG quartile (>35 mmHg, equivalent to estimated pulmonary artery systolic pressure >45 mmHg) occurred in 7% of heart failure patients and correlated with elevated left ventricular filling pressures, increased end-diastolic volume, LVSD, and severe mitral regurgitation.
- Total mortality reached 40.3% during follow-up, rising significantly with increasing RVTG quartiles (log-rank: 26.9; P < 0.0001).
- The highest RVTG quartile, older age, blood pressure, and log NT-proBNP independently predicted mortality, while an RVTG >35 mmHg exhibited 96% specificity in detecting heart failure among patients without LVSD.
Cite This Study
Damy et al. (2010) studied this question.