Abstract 17733: Pulmonary Artery Systolic Pressure by Echocardiography and Outcomes in Stable Outpatients with Heart Failure
Background: Pulmonary hypertension (PH) as measured by right heart catheterization (RHC) portends worse prognosis in heart failure (HF). However, RHC entails risk and its routine use is discouraged. Data regarding echocardiographic pulmonary artery systolic pressure (PASP) estimates and its association with outcomes in HF patients on optimal therapy are limited.
Methods: We examined the association of baseline PASP with (1) survival free of major clinical events (death, urgent transplantation, ventricular assist device [VAD] implantation) and (2) HF and all-cause hospitalization, in 417 patients with available echocardiographic data. We used multivariable restricted splines to identify the optimal PASP cut-off point of PASP for clinical event prediction.
Results: Patient characteristics are presented in Table 1. Mean PASP was 38±14 mmHg. After 2.7±1.3 years, there were 72 major clinical events (death: 57; transplantation: 9; VAD: 6). A PASP >48 mmHg was most strongly associated with risk for events (Figure 1). In models adjusting for demographics, etiology, left ventricular ejection fraction, sodium levels, renal function, and therapy, PASP >48 mmHg was still associated with higher risk for events (HR: 3.52; 95% CI: 2.05 to 6.02; P<0.001). Patients with PASP >48 mmHg had also a higher rate of HF hospitalizations (74 vs. 31 per 100 patient-years; adjusted incidence rate ratio [IRR]: 1.67; 95% CI: 1.14 to 2.45; P=0.008) and all-cause hospitalizations (137 vs. 79 per 100 patient-years; adjusted IRR: 1.44; 95% CI: 1.04 to 2.01; P=0.029).
Conclusion: In HF outpatients, a PASP >48 mmHg by echocardiography predicts higher risk of clinical events and higher hospitalization rates.
- © 2012 by American Heart Association, Inc.