Affordable Access

deepdyve-link
Publisher Website

Increased Pulmonary-Systemic Pulse Pressure Ratio Is Associated With Increased Mortality in Group 1 Pulmonary Hypertension.

Authors
  • Ruth, Benjamin K1
  • Bilchick, Kenneth C2
  • Mysore, Manu M1
  • Mwansa, Hunter3
  • Harding, William C1
  • Kwon, Younghoon2
  • Kennedy, Jamie L W2
  • Mazurek, Jeremy A4
  • Mihalek, Andrew D2
  • Smith, LaVone A2
  • Mejia-Lopez, Eliany2
  • Parker, Alex M2
  • Welch, Timothy S5
  • Mazimba, Sula6
  • 1 Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
  • 2 Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA.
  • 3 St Vincent Charity Medical Center, Case Western Reserve University, Cleveland, OH, USA.
  • 4 Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • 5 Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA; Cardiology Service Walter Reed National Military Medical Center, Bethesda, MD, USA.
  • 6 Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: [email protected]
Type
Published Article
Journal
Heart, lung & circulation
Publication Date
Jul 01, 2019
Volume
28
Issue
7
Pages
1059–1066
Identifiers
DOI: 10.1016/j.hlc.2018.05.199
PMID: 30006114
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Pulmonary arterial hypertension (PAH) is characterised by remodelling of the pulmonary vasculature leading to right ventricular (RV) failure. The failing RV, through interventricular uncoupling, deleteriously impacts the left ventricle and overall cardiac efficiency. We hypothesised that the ratio of the pulmonary artery pulse pressure to the systemic pulse pressure ("pulmonary-systemic pulse pressure ratio", or PS-PPR) would be associated with mortality in PAH. We conducted a retrospective analysis of 262 patients in the National Institute of Health Primary Pulmonary Hypertension Registry (NIH-PPH). We evaluated the association between the PS-PPR and mortality after adjustment for the Pulmonary Hypertension Connection (PHC) risk equation. Among 262 patients (mean age 37.5±15.8years, 62.2% female), median PS-PPR was 1.04 (IQR 0.79-1.30). In the Cox proportional hazards regression model, each one unit increase in the PS-PPR was associated with more than a two-fold increase in mortality during follow-up (HR 2.06, 95% CI 1.40-3.02, p=0.0002), and this association of PS-PPR with mortality remained significant in the multivariable Cox model adjusted for the PHC risk equation, mean pulmonary artery pressure, and body mass index (BMI) (adjusted HR 1.81, 95% CI 1.13-2.88, p=0.01). Furthermore, PS-PPR in the upper quartile (>1.30) versus quartiles 1-3 was associated with a 68% increase in mortality after adjustment for these same covariates (adjusted HR 1.68, 95% CI 1.13-2.50, p=0.01). Pulmonary-systemic pulse pressure ratio, a marker of biventricular efficiency, is associated with survival in PAH even after adjustment for the PHC risk equation. Further studies are needed on the wider applications of PS-PPR in PAH patients. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Report this publication

Statistics

Seen <100 times