PASP predictor for mortality in heart failure patients
MedWire News: Pulmonary artery systolic pressure (PASP) is a strong predictor for mortality in patients with heart failure (HF), a study suggests.
PASP "provides incremental and clinically relevant prognostic information independently of known predictors of outcomes," say Véronique Roger (Mayo Clinic, Rochester, Minnesota, USA) and co-authors in the Journal of the American College of Cardiology.
Their study included 1049 Olmsted Country residents with HF who prospectively underwent assessment of ejection fraction, diastolic function, and PASP using Doppler echocardiography.
Patients were classified into tertiles according to their PASP: less than 41 mmHg, 41-54 mmHg, and over 54 mmHg. Among patients with a PASP of less than 41 mmHg, 64.4% had a normal PASP (defined as ≤35 mmHg).
After a mean follow-up period of 2.7 years, 489 patients died. There was a strong positive graded association between PASP and risk for all-cause mortality (p<0.001). Indeed, 1-year mortality estimates for patients in PASP tertiles 1, 2, and 3 were 8%, 19%, and 28%, respectively.
Compared with patients in the lowest tertile, those in the middle tertile had an unadjusted 72% increased risk for mortality, whereas patients in the highest tertile had a more than twofold increased risk for mortality. After adjusting for age, gender, and several traditional prognostic factors including HF status, comorbidity, and anemia, these results were attenuated but remained significant.
Over the follow-up period, 218 patients died from cardiovascular (CV) causes. There was also a graded association between PASP and risk for CV-specific death (p<0.001), with the 1-year mortality estimates for patients in tertiles 1, 2, and 3 being 4%, 10%, and 17%, respectively.
After multivariate adjustment, patients in the middle tertile had a 75% increased risk for CV death, whereas patients in the highest tertile were 2.5-times more likely to die from CV causes than those in the lowest tertile.
The addition of PASP to a prognostic model including age, gender, incident HF status, comorbidity index, anemia, left ventricular ejection fraction, diastolic function, and chronic obstructive pulmonary disease resulted in an increase in the c-statistic from 0.704 to 0.742 (p=0.007), an integrated discrimination improvement of 4.2% (p<0.001), and a net reclassification improvement of 14.1% (p=0.002). This indicated that PASP "offered additional value in predicting 1-year all-cause mortality over traditional prognostic factors," report the authors.
Similar results were observed when predicting CV mortality.
Bursi and team conclude: "The present data indicate that pulmonary pressures can be readily assessed by Doppler echocardiography among patients with HF in the community and that pulmonary hypertension is overwhelmingly present in this setting."
In a related commentary, editorialists Myung Park (University of Maryland, Baltimore, USA) and Mandeep Mehra (Brigham and Women's Hospital, Boston, Massachusetts, USA) write: "We are slowly but surely beginning to advance our understanding of the importance of [pulmonary hypertension] in heterogeneous disease states across the spectrum of ventricular abnormalities, valvular abnormalities, congenital malformation states, and diseases isolated to the pulmonary arterial vasculature."
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By Piriya Mahendra