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

Pubmed ID: 30006114

Journal: Heart, lung & circulation

Publication Date: July 1, 2019

Affiliation: Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: SM8SD@hscmail.mcc.virginia.edu.

Link: https://ac.els-cdn.com/S1443950618317700/1-s2.0-S1443950618317700-main.pdf?_tid=1cdaad84-fbfc-4268-8da8-f9ca8df7e6e4&acdnat=1540984568_123a418bb26d65f44b004243da630356&link_time=2024-03-28_12:39:57.249452

MeSH Terms: Humans, Male, Adult, Female, Middle Aged, Blood Pressure, Retrospective Studies, Databases, Factual, Heart Rate, Ventricular Dysfunction, Right, Familial Primary Pulmonary Hypertension

Authors: Mazimba S, Bilchick KC, Kwon Y, Mihalek AD, Mejia-Lopez E, Mwansa H, Parker AM, Kennedy JLW, Welch TS, Harding WC, Mysore MM, Ruth BK, Mazurek JA, Smith LA

Cite As: Ruth BK, Bilchick KC, Mysore MM, Mwansa H, Harding WC, Kwon Y, Kennedy JLW, Mazurek JA, Mihalek AD, Smith LA, Mejia-Lopez E, Parker AM, Welch TS, Mazimba S. Increased Pulmonary-Systemic Pulse Pressure Ratio Is Associated With Increased Mortality in Group 1 Pulmonary Hypertension. Heart Lung Circ 2019 Jul;28(7):1059-1066. Epub 2018 Jun 21.

Studies:

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.