Prevalence and prognostic significance of pulmonary hypertension in adults with left ventricular diastolic dysfunction.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2024-12-03 DOI:10.1136/openhrt-2024-003049

Seshika Ratwatte, David Playford, Geoff Strange, David S Celermajer, Simon Stewart

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引用次数: 0

Abstract

Aims: Pulmonary hypertension (PHT) appears to be very common in heart failure with preserved ejection fraction but details on its prevalence, severity and prognostic implications have not been well defined. We, therefore, aimed to document PHT and its impact on mortality among adults with left ventricular (LV) diastolic dysfunction (LVDD).

Methods: We analysed the profile and outcomes of 16 058 adults with LVDD (and with preserved LV ejection fraction, >50%) from the National Echocardiography Database of Australia. Subjects were classified according to their peak tricuspid regurgitation velocity (TRV), reflecting PHT risk, and we then evaluated the relationship between conventional thresholds of increasing risk of PHT and subsequent mortality, during median follow-up of 3.1 (IQR 1.6-5.2) years.

Results: Mean age was 73±12 years and 9216 (57.4%) were female. Overall, 2611 (16.3%) had normal TRV levels (<2.5 m/s) indicative of no PHT, compared with 3471 (21.6%), 8450 (52.6%) and 1526 (9.5%) with TRV levels indicative of borderline (2.5-2.8 m/s), intermediate (2.9-3.4 m/s) and high-risk for PHT (>3.4 m/s). The 1-year and 5-year actuarial mortality (1701/1546 and 4232/8445 deaths, respectively) increased from 6.5% and 34.0% to 27.7% and 78.5%, respectively (p<0.0001), from normal to severely elevated TRV. Adjusted risk (HR) of mortality increased 1.28-fold (95% CI 1.15 to 1.41), 1.51-fold (95% CI 1.38 to 1.65) and 3.47-fold (95% CI 3.13 to 3.85) in those with borderline, intermediate and high risk of PHT versus normal TRV. This observation persisted when excluding atrial fibrillation cases, and when male and female cohorts were assessed separately. Mortality rates increased perceptibly at the second decile distribution of TRV (2.37-2.55 m/s) with a marked increase in mortality from the fifth decile (2.91-3.00 m/s) upwards.

Conclusion: We demonstrate the negative prognostic impact of elevated TRV levels in many adults with isolated LVDD. A threshold of increased mortality was observed at TRV levels equivalent to 'borderline risk' of PHT.

Trial registration number: ACTRN12617001387314.

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左室舒张功能不全成人肺动脉高压的患病率及预后意义。

目的：肺动脉高压（PHT）似乎在保留射血分数的心力衰竭中非常常见，但其患病率、严重程度和预后影响的细节尚未得到很好的定义。因此，我们的目的是记录PHT及其对左室舒张功能障碍（LVDD）成人死亡率的影响。方法：我们分析了来自澳大利亚国家超声心动图数据库的16058例LVDD成人（保留左室射血分数，bbb50 %）的概况和结果。根据反映PHT风险的三尖瓣反流速度（TRV）对受试者进行分类，然后在中位随访3.1 （IQR 1.6-5.2）年期间评估PHT风险增加的常规阈值与随后死亡率之间的关系。结果：平均年龄73±12岁，女性9216例，占57.4%。总的来说，2611例（16.3%）TRV水平正常（3.4 m/s）。1年和5年精算死亡率（分别为1701/1546和4232/8445）分别从6.5%和34.0%上升到27.7%和78.5%(结论：我们证明了TRV水平升高对许多孤立性LVDD成人的预后有负面影响。在TRV水平相当于PHT的“临界风险”时，观察到死亡率增加的阈值。试验注册号：ACTRN12617001387314。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.