Why the study?
Pulmonary hypertension is associated with poor prognosis in left heart disease, prompting an updated analysis of the prognostic association of hemodynamic variables including PVR, PAC, and DPG.
Do hemodynamic variables (PVR, PAC, DPG) predict adverse outcomes in patients with pulmonary hypertension due to left heart disease?
Meta-Analysis (n=9,600)
Do hemodynamic variables (PVR, PAC, DPG) predict adverse outcomes in patients with pulmonary hypertension due to left heart disease?
Hazard Ratio: 1.07 (95% CI 1.05–1)
PVR, DPG, and PAC have an established and stable prognostic value for predicting adverse outcomes in patients with pulmonary hypertension due to left heart disease.
Pulmonary hypertension (PH) is associated with a poor prognosis in left heart disease (LHD). We sought to provide an updated analysis on the association of hemodynamic variables, such as pulmonary vascular resistance (PVR), pulmonary artery compliance (PAC), and diastolic pressure gradient (DPG), with prognosis in PH-LHD, through a systematic literature review. Sixteen articles were identified, including 9600 patients with LHD, heterogeneous in terms of age, sex, and etiology of cardiac disease. In this large population, PVR (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.05-1.0), DPG (HR, 1.02; 95% CI: 1.01-1.02) and PAC (HR, 0.76; 95% CI: 0.69-0.84) were associated with an increased risk of adverse outcome, albeit with a less solid performance of DPG. Similar results were found when hemodynamic variables were analyzed according to the thresholds commonly applied in clinical practice, or subdividing cohorts according to the underlying LHD. Furthermore, cumulative metanalysis indicated that these results are consistently stable since 2018. Thus, PVR, DPG and PAC have an established prognostic value in PH-LHD. These results are consistent through the years and unlikely to change with further studies.
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Baratto et al. (2022) conducted a meta-analysis in Pulmonary hypertension due to left heart disease (n=9,600). Hemodynamic variables (PVR, DPG, PAC) was evaluated on Adverse outcome (HR 1.07, 95% CI 1.05-1.0).
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