Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the VA-CART Program
| Autor: | Tim Lahm, Maggie A. Stanislawski, Karen E. Joynt, Mary E. Plomondon, Anna E. Barón, Alexander R. Opotowsky, Jean M. Elwing, John S. Rumsfeld, Gaurav Choudhary, Edward Hess, Daniel J. Kass, Erik R. Swenson, Thomas M. Maddox, Jane A. Leopold, Ryan J. Tedford, Bradley A. Maron, Gary K. Grunwald, Roham T. Zamanian, Ronald H. Goldstein, Thomas Stephens |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Research Report medicine.medical_specialty Cardiac Catheterization Hypertension Pulmonary 030204 cardiovascular system & hematology Article Cohort Studies 03 medical and health sciences 0302 clinical medicine Physiology (medical) medicine Humans Mortality Intensive care medicine Veterans Affairs Cardiopulmonary disease Aged Retrospective Studies Veterans Aged 80 and over Proportional hazards model business.industry Hazard ratio Retrospective cohort study Middle Aged Confidence interval United States Hospitalization United States Department of Veterans Affairs 030228 respiratory system Emergency medicine Cohort Hypertension Female Cardiology and Cardiovascular Medicine business Cohort study |
| Popis: | Background— Pulmonary hypertension (PH) is associated with increased morbidity across the cardiopulmonary disease spectrum. Based primarily on expert consensus opinion, PH is defined by a mean pulmonary artery pressure (mPAP) ≥25 mm Hg. Although mPAP levels below this threshold are common among populations at risk for PH, the relevance of mPAP Methods and Results— We analyzed retrospectively all US veterans undergoing right heart catheterization (2007–2012) in the Veterans Affairs healthcare system (n=21 727; 908-day median follow-up). Cox proportional hazards models were used to evaluate the association between mPAP and outcomes of all-cause mortality and hospitalization, adjusted for clinical covariates. When treating mPAP as a continuous variable, the mortality hazard increased beginning at 19 mm Hg (hazard ratio [HR]=1.183; 95% confidence interval [CI], 1.004–1.393) relative to 10 mm Hg. Therefore, patients were stratified into 3 groups: (1) referent (≤18 mm Hg; n=4 207); (2) borderline PH (19–24 mm Hg; n=5 030); and (3) PH (≥25 mm Hg; n=12 490). The adjusted mortality hazard was increased for borderline PH (HR=1.23; 95% CI, 1.12–1.36; P P P =0.0149) and PH (HR=1.15; 95% CI, 1.09–1.22; P 15 mm Hg; (2) pulmonary vascular resistance ≥3.0 Wood units; or (3) inpatient status at the time of right heart catheterization. Conclusions— These data illustrate a continuum of risk according to mPAP level and that borderline PH is associated with increased mortality and hospitalization. Future investigations are needed to test the generalizability of our findings to other populations and study the effect of treatment on outcome in borderline PH. |
| Databáze: | OpenAIRE |
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