Chest
Elevated Pulmonary Artery Pressure: An Independent Predictor of Mortality
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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.