What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected pulmonary hypertension (n=140). Intervention: Mean pulmonary artery pressure (mPAP) 21-24 mmHg vs. mPAP <21 mmHg. Primary outcome: All-cause mortality (p=0.063).

January 1, 2023Open Access

Long-Term Natural Course of Patients with Pulmonary Artery Pressures in the Range of 21–24 mmHg: Insights from a Single-Center Study

Q: What are the key findings of this study?

Mean pulmonary artery pressure of 21-24 mmHg was associated with a non-significant trend toward higher all-cause mortality (37.1% vs 22.5%, p=0.063) compared to mPAP <21 mmHg over a mean 4.9-year follow-up.

Key Result

Mean pulmonary artery pressure of 21-24 mmHg was associated with a non-significant trend toward higher all-cause mortality (37.1% vs 22.5%, p=0.063) compared to mPAP <21 mmHg over a mean 4.9-year follow-up.

Study Design

Type

Cohort (n=140)

Multicenter

Structured PICO

Does borderline pulmonary hypertension (mPAP 21-24 mmHg) worsen all-cause mortality compared to mPAP <21 mmHg in patients with suspected pulmonary hypertension?

Population

140 patients with moderate-to-high echocardiographic risk who underwent right heart catheterization with mPAP <25 mmHg, mean age 53.1 ± 14.8 years, 74.5% female.

Intervention

mPAP 21-24 mmHg (borderline pulmonary hypertension)

Comparator

mPAP <21 mmHg

Outcome

All-cause mortality over a mean follow-up of 5 yearshard clinical

Patients with borderline pulmonary hypertension (mPAP 21-24 mmHg) tend to have a worse prognosis and more deteriorated hemodynamics compared to those with mPAP <21 mmHg, though mortality differences were not statistically significant.

Main Result

Absolute Event Rate: 37.1% vs 22.5%

p-value: p=0.063

Limitations

Retrospective nature of the study
Data collected from a single center
Limited number of patients
Center predominantly receives referrals for congenital heart disease, which may impact generalizability
Small sample size prevented subgroup analysis for systemic sclerosis patients

Abstract

OBJECTIVE: Slightly elevated mean pulmonary artery pressure (mPAP) was previously termed as ''borderline pulmonary hypertension (PH)''. We examined the long-term prognosis of patients with mPAP values between 21 and 24 mmHg, who were referred with the suspicion of pulmonary hypertension. METHODS: Our retrospective study included patients with moderate-to-high echocardiographic risk who underwent right heart catheterization (RHC) between 2008 and 2021 and were followed for at least 1 year. Patients with mPAP <21 mmHg and mPAP 21-24 mmHg were compared. Demographic and clinical characteristics and prognoses of the groups were compared. All-cause mortality over a mean follow-up of 5 years (min 1-max 13 years) was evaluated. RESULTS: A total of 140 patients (mean age 53.1 ± 14.8 years, female 74.5%) with mPAP values <25 mmHg measured of the 395 diagnostic RHCs. Mean follow-up was 4.92 ± 3.13 years. NT-pro-BNP and 6-min walking distance were better in patients with mPAP <21 mmHg. Echocardiographic findings suggestive of PH were more common in mPAP 21-24 mmHg group (P < 0.05). Both the pulmonary artery wedge pressure and cardiac index values were significantly deteriorated in individuals with mPAP 21-24 mmHg (P = 0.001). All-cause mortality tended to be higher in the borderline PH group but did not reach to statistical significance. CONCLUSION: Our single-center observational study revealed that the individuals with an mPAP of 21-24 mmHg tended to have a worser prognosis than those with mPAP of <21 mmHg for up to 13-year follow-up.

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