Effect of Group 2 Pulmonary Hypertension Subgroups on Outcomes: Impact of the Updated Definition of Pulmonary Hypertension
Heart Lung and Circulation, cilt.31, sa.4, ss.508-519, 2022 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 31 Sayı: 4
- Basım Tarihi: 2022
- Doi Numarası: 10.1016/j.hlc.2021.10.002
- Dergi Adı: Heart Lung and Circulation
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE
- Sayfa Sayıları: ss.508-519
- Anahtar Kelimeler: End-stage heart failure, Updated pulmonary hypertension definition, Outcomes, Combined pre-and postcapillary pulmonary hypertension, Isolated postcapillary pulmonary hypertension
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Pulmonary hypertension (PH) is a common complication of end-stage heart failure (ESHF) and associated with increased mortality. The definition of PH has recently been changed from a mean pulmonary arterial pressure (PAPm) ≥25 mmHg to a PAPm >20 mmHg. Since this change, there are no data evaluating group 2 PH subgroups on outcomes. The purpose of this study was to determine the impact of updated group 2 PH subgroups on outcomes, as well as to evaluate the clinical, echocardiographic, and haemodynamic characteristics of subgroups, and determine predictors of PH in patients with ESHF. Method: A total of 416 patients with ESHF with left ventricular ejection fraction (LVEF) ≤25% were divided into three groups. Pulmonary hypertension was defined as PAPm >20 mmHg. Primary outcome was defined as left ventricular assist device (LVAD) implantation, urgent heart transplantation (HT), or death. Secondary outcome was defined as LVAD implantation and HT. Results: Over a median follow-up of 503.5 days, combined pre- and postcapillary PH (Cpc-PH) displayed greater risk of primary outcome than those with isolated postcapillary (Ipc-PH) (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.29–1.91; p<0.001) and those with no PH (HR, 2.47; 95% CI, 1.68–3.63; p<0.001). Patients with Ipc-PH demonstrated greater risk than those with no PH (HR, 1.57; 95% CI, 1.57–1.90; p<0.001). Likelihood ratios of updated PH criteria and old PH criteria (PAPm ≥25 mmHg) in identifying primary outcome were 75.6 (R2=0.179) and 72.09 (R2=0.164). Patients with PAPm 21–24 mmHg had a higher primary outcome than those with PAPm ≤20 mmHg. Severe mitral regurgitation, LVEF, grade 3 diastolic dysfunction, diabetes, and cardiac output were predictors of PH. Conclusions: Pulmonary hypertension increases the risk of LVAD, urgent HT, or death, and Cpc-PH further increases risk in patients with ESHF. Compared to the previous definition, a new PH definition better discriminates death, going to urgent HT, or LVAD implantation for PH subgroups.