Clinical features do not identify risk of progression from isolated postcapillary pulmonary hypertension to combined pre‐ and postcapillary pulmonary hypertension

Author:

Babu Gautam1ORCID,Annis Jeffrey S.1,Garry Jonah D.2,Freiberg Matthew S.3,Hemnes Anna R.3,Brittain Evan L.24

Affiliation:

1. Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA

2. Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA

3. Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Nashville Tennessee USA

4. Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Research Center Vanderbilt University Medical Center Nashville Tennessee USA

Abstract

AbstractPulmonary hypertension is a common sequelae of left heart failure and may present as isolated postcapillary pulmonary hypertension (Ipc‐PH) or combined pre‐ and postcapillary pulmonary hypertension (Cpc‐PH). Clinical features associated with progression from Ipc‐PH to Cpc‐PH have not yet been described. We extracted clinical data from patients who underwent right heart catheterizations (RHC) on two separate occasions. Ipc‐PH was defined as mean pulmonary pressure >20 mmHg, pulmonary capillary wedge pressure >15 mmHg, and pulmonary vascular resistance (PVR) < 3 WU. Progression to Cpc‐PH required an increase in PVR to ≥3 WU. We performed a retrospective cohort study with repeated assessments comparing subjects that progressed to Cpc‐PH to subjects that remained with Ipc‐PH. Of 153 patients with Ipc‐PH at baseline who underwent a repeat RHC after a median of 0.7 years (IQR 0.2, 2.1), 33% (50/153) had developed Cpc‐PH. In univariate analysis comparing the two groups at baseline, body mass index (BMI) and right atrial pressure were lower, while the prevalence of moderate or worse mitral regurgitation (MR) was higher among those who progressed. In age‐ and sex‐adjusted multivariable analysis, only BMI (OR 0.94, 95% CI 0.90–0.99, p = 0.017, C = 0.655) and moderate or worse MR (OR 3.00, 95% CI 1.37–6.60, p = 0.006, C = 0.654) predicted progression, but with poor discriminatory power. This study suggests that clinical features alone cannot distinguish patients at risk for development of Cpc‐PH and support the need for molecular and genetic studies to identify biomarkers of progression.

Funder

Foundation for the National Institutes of Health

Publisher

Wiley

Subject

Pulmonary and Respiratory Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3