Cargando…

Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure

BACKGROUND: Pulmonary hypertension is common among patients with heart failure (HF). Right ventricular systolic pressure (RVSP) is frequently used to assess its presence and severity. Although RVSP has been associated with adverse outcomes, the importance of serial measurements has not been studied....

Descripción completa

Detalles Bibliográficos
Autores principales: Kotrri, Gynter, Youngson, Erik, Fine, Nowell M., Howlett, Jonathan G., Lyons, Kristin, Paterson, D. Ian, Ezekowitz, Justin, McAlister, Finlay A., Miller, Robert J.H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10516718/
https://www.ncbi.nlm.nih.gov/pubmed/37744660
http://dx.doi.org/10.1016/j.cjco.2023.05.011
_version_ 1785109186479128576
author Kotrri, Gynter
Youngson, Erik
Fine, Nowell M.
Howlett, Jonathan G.
Lyons, Kristin
Paterson, D. Ian
Ezekowitz, Justin
McAlister, Finlay A.
Miller, Robert J.H.
author_facet Kotrri, Gynter
Youngson, Erik
Fine, Nowell M.
Howlett, Jonathan G.
Lyons, Kristin
Paterson, D. Ian
Ezekowitz, Justin
McAlister, Finlay A.
Miller, Robert J.H.
author_sort Kotrri, Gynter
collection PubMed
description BACKGROUND: Pulmonary hypertension is common among patients with heart failure (HF). Right ventricular systolic pressure (RVSP) is frequently used to assess its presence and severity. Although RVSP has been associated with adverse outcomes, the importance of serial measurements has not been studied. We evaluated associations between serial RVSP measurements and cardiovascular events in patients with HF. METHODS: Patients with HF and 2 echocardiograms performed ≥ 6 months apart were included. RVSP was categorized, using the second echocardiogram, as follows: normal (< 40 mm Hg); severely elevated (≥ 60 mm Hg); moderately elevated (50-59 mm Hg); or mildly elevated (40-49 mm Hg). Patients also were classified according to change in RVSP categories between echocardiograms. The primary outcome was time to HF hospitalization (HFH) or all-cause mortality (ACM) after the second echocardiogram. RESULTS: In total, 4319 patients were included (median age: 78 years; 52.1% female). During a median follow-up period of 19.4 months, HFH/ACM occurred in 2714 patients (62.8%). In multivariable analysis, baseline RSVP that was mildly elevated (1069 patients, hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.12-1.54), moderately elevated (797 patients, HR 1.54, 95% CI 1.30-1.82), or severely elevated (837 patients, HR 1.92, 95% CI 1.60-2.31) was independently associated with HFH/ACM. Additionally, improving RVSP was associated with increased HFH/ACM in both categorical (HR 1.16, 95% CI 1.01-1.33) and continuous analyses. CONCLUSIONS: RVSP measurements identify patients at increased risk who may require more-aggressive monitoring and medical therapy. Our study raises the hypothesis that, in addition to the absolute value of RVSP, improving RVSP category may identify higher-risk patients, but further study is needed to elucidate the underlying reasons.
format Online
Article
Text
id pubmed-10516718
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-105167182023-09-23 Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure Kotrri, Gynter Youngson, Erik Fine, Nowell M. Howlett, Jonathan G. Lyons, Kristin Paterson, D. Ian Ezekowitz, Justin McAlister, Finlay A. Miller, Robert J.H. CJC Open Original Article BACKGROUND: Pulmonary hypertension is common among patients with heart failure (HF). Right ventricular systolic pressure (RVSP) is frequently used to assess its presence and severity. Although RVSP has been associated with adverse outcomes, the importance of serial measurements has not been studied. We evaluated associations between serial RVSP measurements and cardiovascular events in patients with HF. METHODS: Patients with HF and 2 echocardiograms performed ≥ 6 months apart were included. RVSP was categorized, using the second echocardiogram, as follows: normal (< 40 mm Hg); severely elevated (≥ 60 mm Hg); moderately elevated (50-59 mm Hg); or mildly elevated (40-49 mm Hg). Patients also were classified according to change in RVSP categories between echocardiograms. The primary outcome was time to HF hospitalization (HFH) or all-cause mortality (ACM) after the second echocardiogram. RESULTS: In total, 4319 patients were included (median age: 78 years; 52.1% female). During a median follow-up period of 19.4 months, HFH/ACM occurred in 2714 patients (62.8%). In multivariable analysis, baseline RSVP that was mildly elevated (1069 patients, hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.12-1.54), moderately elevated (797 patients, HR 1.54, 95% CI 1.30-1.82), or severely elevated (837 patients, HR 1.92, 95% CI 1.60-2.31) was independently associated with HFH/ACM. Additionally, improving RVSP was associated with increased HFH/ACM in both categorical (HR 1.16, 95% CI 1.01-1.33) and continuous analyses. CONCLUSIONS: RVSP measurements identify patients at increased risk who may require more-aggressive monitoring and medical therapy. Our study raises the hypothesis that, in addition to the absolute value of RVSP, improving RVSP category may identify higher-risk patients, but further study is needed to elucidate the underlying reasons. Elsevier 2023-06-03 /pmc/articles/PMC10516718/ /pubmed/37744660 http://dx.doi.org/10.1016/j.cjco.2023.05.011 Text en © 2023 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Kotrri, Gynter
Youngson, Erik
Fine, Nowell M.
Howlett, Jonathan G.
Lyons, Kristin
Paterson, D. Ian
Ezekowitz, Justin
McAlister, Finlay A.
Miller, Robert J.H.
Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title_full Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title_fullStr Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title_full_unstemmed Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title_short Right Ventricular Systolic Pressure Trajectory as a Predictor of Hospitalization and Mortality in Patients With Chronic Heart Failure
title_sort right ventricular systolic pressure trajectory as a predictor of hospitalization and mortality in patients with chronic heart failure
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10516718/
https://www.ncbi.nlm.nih.gov/pubmed/37744660
http://dx.doi.org/10.1016/j.cjco.2023.05.011
work_keys_str_mv AT kotrrigynter rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT youngsonerik rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT finenowellm rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT howlettjonathang rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT lyonskristin rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT patersondian rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT ezekowitzjustin rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT mcalisterfinlaya rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure
AT millerrobertjh rightventricularsystolicpressuretrajectoryasapredictorofhospitalizationandmortalityinpatientswithchronicheartfailure