Abstract 11993: Prognostic Value of Pulmonary Hypertension in Heart Failure
Purpose: In chronic left heart sides diseases the onset of pulmonary hypertension [PH] marks an important change in clinical picture and evolution of disease, usually associated with increased morbidity and mortality. We studied a population of patients with pulmonary hypertension secondary to heart failure in order to verify the predictive value of systolic pulmonary artery pressure [sPAP] in terms of clinical evolution and survival, and to seek potential clinical and instrumental parameters indicative of progress.
Method: We evaluated clinical-anamnestic parameters, laboratory data, electrocardiographic and echocardiographic characteristics in 170 patients (follow-up of 31±24 months) with at least once a sPAP ≥50 mmHg. We analyzed as subgroups, dead [D] vs survived [S] and subjects with worsening evolution of the sPAP [WP] with those where the sPAP was decreased or remained stable over time [DP].
Results: In D group were prevalent NYHA classes III-IV and there was an increase over time in prevalence of NYHA class IV and in mean NYHA, parameters substantially unchanged in S group. In follow-up the D group exhibited a more pronounced deterioration of renal function (p=0.01), a significantly higher mean dose of diuretic (p<0.0001) and a greater increase in dosage of the same (p=0.01). Renal function was also more markedly decreased in WP than in DP group (p=0.03). Systolic pulmonary artery pressure has been significantly higher in D than in S group (54.5±13.9 vs 50.5±12.3 mmHg, p=0.009). The average degree of diastolic dysfunction and the fraction of irreversible restrictive pattern were significantly higher in D than S group (p=0.04). In the WP group the irreversible restrictive pattern was significantly more frequent (p=0.005) and rising over time (p<0.0001); instead in the DP group we observed a prevalence of altered relaxation pattern (p=0.02) that increase over time (p<0.0001). We also found a direct linear relationship between sPAP and diastolic dysfunction temporal variations (R 0.65, p<0.0001).
Conclusions: Worsening evolution of sPAP, impaired renal function and progression of diastolic dysfunction appear tightly inter-related and key factors conditioning the outcome of patients with secondary PH.
- © 2011 by American Heart Association, Inc.