Chest
Volume 99, Issue 1, January 1991, Pages 112-120
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Elevated Pulmonary Artery Pressure: An Independent Predictor of Mortality

https://doi.org/10.1378/chest.99.1.112Get rights and content

Analyses in this study were based on hemodynamic and angiographic data obtained in a cohort of 1,371 predominantly black patients during right and left heart catheterization. All patients were followed up prospectively for a mean of 117 weeks, and 103 fatal events were recorded. In Cox survival analysis, three variables were found to be independently related to survival: pulmonary artery mean pressure (PAMP), number of stenosed vessels, and left ventricular (LV) ejection fraction (p<0.01); in multivariate stepwise analysis, PAMP entered the model first with the largest χ2 value of the three prognostic variables (χ2=33.4; p<0.0001). The PAMP was 32 percent higher in decedents compared with survivors (25 + 11 mm Hg vs 19+8 mm Hg, p<0.01 [mean, SD]) and a 10 mm Hg increase in PAMP was associated with a more than fourfold increase in the relative risk of dying; this finding was independent of pulmonary vascular resistance and therefore could not be attributed to primary pulmonary vascular or parenchymal disease. In both the subgroup of 1,118 patients with a normal LV ejection fraction (>50 percent) and the 253 patients with a reduced ejection fraction (<50 percent), PAMP emerged as an independent predictor of mortality (p<0.0001 and 0.01, respectively), and is therefore a marker of cardiac disease beyond impairment of systolic contractile function. Among patients without obstructive coronary artery disease, PAMP alone provided prognostic information in the multivariate survival analysis. (Chest 1991; 99:112–20)

Section snippets

Database

Information describing the clinical history, resting electrocardiogram, hemodynamics, and coronary arteriogram was prospectively collected in the Cook County Hospital (Chicago) Heart Disease Registry on 1,749 patients undergoing cardiac catheterization for presumed CAD between June 1982 and December 1987. All patients with valvular and congenital heart disease were excluded from the present analysis. A total of 378 patients were eliminated because of missing information on either pulmonary

RESULTS

The descriptive characteristics of the entire cohort of 1,371 patients, survivors compared with decedents, are presented in Table 1. Most of the patients were blacks while the proportion of male sex was higher among patients who died. Hypertension was common in both groups and electrocardiographic (ECG) evidence of LVH was present in almost one third of each group. Among the medical history variables, only a history of myocardial infarction was more prevalent in the decedents.

As anticipated,

DISCUSSION

The data presented herein demonstrate that among a cohort of patients with a high prevalence of hypertension and LVH, important prognostic information was contained in the measurement of the hemodynamics of the pulmonary circulation. Across a wide spectrum of functional and structural cardiac abnormalities, pulmonary pressure appeared as the strongest predictor of mortality, entirely independent of the severity of coronary atherosclerosis, level of LVEF, and the degree of LVH. This predictive

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This work was supported by NIH Grant RO1 HL36723.

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