Abstract 19588: How High Is Too High? - What Degree of Pulmonary Hypertension Predicts Poor Outcome In Patients With Left Ventricular Systolic Dysfunction ?
Background: The presence of pulmonary hypertension in heart failure is an ominous sign. It remains unclear the level at which pulmonary hypertension coveys mortality risk in patients with heart failure.
Methods: This study was done in Tayside, Scotland (population approximately 400 000) using data linked anonymously by a community health index number from the Tayside echocardiogram database (> 100,000 echos), outcome data and all healthcare activities maintained by the Health Informatics Centre. Patients were included in the analysis if they had impaired left ventricular systolic function (EF<40%) and had Right Ventricular Pressure (RVSP) measurement. Cox proportional hazards model was used to examine the impact of different ranges of RVSP measures on all cause mortality using age and sex as co-variants. Outcome was defined as all cause mortality. Comparisons were for the specified range against the rest of the cohort.
Results: 3920 patients (mean age 74.X±11.7 yrs; 57 % male) met entry criteria. RVSP was correlated with poor survival (p<0.0001) for the entire cohort. All cause mortality was related to the degree of RVSP with a significant increase in mortality when RVSP >50 mmHg (RVSP 50–60 mmHg, (HR 1.3; 95% CI 1.01–7.90); age 51–60yrs (HR 2.70; 95% CI 1.80–4.08); age 61–70yrs (HR 1.72; 95% CI 1.42–2.08); age 71–80yrs (HR 1.28; 95% CI1.15–1.43); age 80–90yrs (HR 1.29; 95% CI 1.16–1.43); age> 90 yrs (HR 0.91; 95% CI 0.74 – 1.13); [figure]
Conclusions: Right ventricular systolic pressure estimation by echocardiography of greater than 50 mmHg is associated with poor outcome in patients with systolic heart failure.
- © 2010 by American Heart Association, Inc.