Abstract 14809: Out of Proportion Pulmonary Hypertension Has the Long-Term Prognostic Significance in Patients Admitted With Acute Decompensated Heart Failure, Regardless of Reduced or Preserve Left Ventricular Ejection Fraction
Backgroud: Pulmonary hypertension (PH) in patients with heart failure, which is associated with a greater mortality rate, is classified as reactive (out of proportion) and passive PH. However, there is little information available on the long-term prognostic significance of these subtypes in patients admitted with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).
Methods and Results: We studied 210 patients admitted for ADHF (HFrEF(LVEF<50%); n=105, HFpEF;n=105) and discharged with survival. Out of proportion PH was defined as mean pulmonary artery pressure ≥25, pulmonary capillary wedge pressure >15 mm Hg, and transpulmonary pressure gradient≥12 mmHg or pulmonary vascular resistance >3 Wood units. At the admission, 82 of 210 patients had out of proportion PH. Baseline clinical and study characteristics were similar between patients with and without out of proportion PH, except for lower body mass index and higher serum blood urea nitrogen level in patients with out of proportion PH.
During a mean follow-up period of 4.4±3.3 yrs, 48 pts had cardiovascular death (CVD). CVD was significantly more frequently observed in patients with than without out of proportion PH (33% vs 16%, p=0.0009). Multivariate Cox regression analysis revealed that out of proportion PH was independently associated with CVD (adjusted hazard ratio: 2.0 (95%CI 1.1-3.5), p=0.04). In HFrEF group, patients with out of proportion PH had a higher risk of CVD than those without that (38% vs 20%, p=0.01, adjusted hazard ratio: 2.5 (95%CI 1.1-5.8)). In HFpEF group, patients with out of proportion PH also had a higher risk of CVD (26% vs 13%, p=0.04, adjusted hazard ratio: 2.8 (95%CI 1.0-8.0)).
Conclusions: Out of proportion PH would be the long-term prognostic factor in patients admitted with ADHF, regardless of HFrEF or HFpEF.
- © 2013 by American Heart Association, Inc.