Mild Elevation of Pulmonary Arterial Pressure as a Predictor of Mortality
Top Cited Papers
- 15 February 2018
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 197 (4), 509-516
- https://doi.org/10.1164/rccm.201706-1215OC
Abstract
Rationale: Normal mean pulmonary arterial pressure (mPAP) is 14.0 +/- 3.3 mm Hg (mean +/- SD). The prognostic relevance of mildly elevated mPAP not fulfilling the definition of pulmonary hypertension (PH; mPAP >= 25 mm Hg) has not been prospectively evaluated in a real-world setting. Objectives: To assess the association of resting mPAPwith all-cause mortality in a retrospective and a prospective cohort of patients with unexplained dyspnea and/or at risk of PH. Methods: Prognostic cutoffs were calculated by means of 1) classification and regression tree (CART) analysis without any preset thresholds, and 2) preset thresholds on the basis of literature data defining mPAP as lower-normal (<= mean + 1 SD), upper-normal (between mean +1 SD and mean + 2 SD), borderline (between mean12 SD and 25 mm Hg), and manifest PH (>= 25 mm Hg). We performed univariate and multivariate survival analysis adjusted for age and comorbidities. Measurements and Main Results: We enrolled 547 patients, of whom 137, 56, 64, and 290 presented with lower-normal, upper-normal, or borderline mPAP, and manifest PH, respectively. The CART analysis on mPAP discriminated three prognostic groups: mPAP less than 17 mm Hg, 17 to 26 mm Hg, and greater than 26 mm Hg, with significantly decreasing survival. The univariate analysis on the basis of preset thresholds showed that upper-normal mPAP, borderline mPAP, and manifest PH were significantly associated with poor survival compared with lower-normal mPAP. In the multivariate model, considering age and comorbidities, only borderline mPAP (hazard ratio, 2.37; 95% confidence interval, 1.14-4.97; P = 0.022) and manifest PH (hazard ratio, 5.05; 95% confidence interval, 2.79-9.12; P < 0.001) were significantly associated with poor survival. Conclusions: In patients at risk for PH and/or with unexplained dyspnea, CART analysis detects prognostic thresholds at a resting mPAP of 17 mm Hg and 26 mm Hg, and values between 20mm Hg and 25mm Hg represent an independent predictor of poor survival.This publication has 34 references indexed in Scilit:
- Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking ProgramCirculation, 2016
- Exercise-induced pulmonary hypertension: at last!European Respiratory Journal, 2015
- 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertensionEuropean Respiratory Journal, 2015
- Clinical Characterization and Survival of Patients with Borderline Elevation in Pulmonary Artery PressurePulmonary Circulation, 2013
- An Evaluation of Long-term Survival From Time of Diagnosis in Pulmonary Arterial Hypertension From the REVEAL RegistrySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- The REVEAL Registry Risk Score Calculator in Patients Newly Diagnosed With Pulmonary Arterial HypertensionSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2012
- Survival in Patients With Idiopathic, Familial, and Anorexigen-Associated Pulmonary Arterial Hypertension in the Modern Management EraCirculation, 2010
- Diagnosis and Assessment of Pulmonary Arterial HypertensionJournal of the American College of Cardiology, 2009
- Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic reviewEuropean Respiratory Journal, 2009
- Survival in Patients with Primary Pulmonary HypertensionAnnals of Internal Medicine, 1991