Prognostic value of mean pulmonary artery pressure in the stable phase after heart transplantation
| Autor: | Frank Enseleit, Frank Ruschitzka, Francesco Maisano, Andreas J. Flammer, Thomas F. Lüscher, Jan-Philip Molkentin, Michelle Frank, Isabella Sudano, Matthias P. Nägele, Markus J. Wilhelm |
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| Přispěvatelé: | University of Zurich, Flammer, Andreas J |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Heart transplantation Cohort Studies Hospitals University 0302 clinical medicine Interquartile range Reference Values Cause of Death Medicine Hazard ratio Central venous pressure General Medicine Middle Aged Prognosis Pulmonary artery pressure 2746 Surgery Treatment Outcome Cardiology 10209 Clinic for Cardiology Female Cardiology and Cardiovascular Medicine Switzerland Pulmonary and Respiratory Medicine Adult medicine.medical_specialty Hypertension Pulmonary 610 Medicine & health Risk Assessment 2705 Cardiology and Cardiovascular Medicine 03 medical and health sciences Internal medicine Confidence Intervals Humans Pulmonary Wedge Pressure Mortality Pulmonary wedge pressure Proportional Hazards Models Retrospective Studies Heart Failure Postoperative Care business.industry medicine.disease Pulmonary hypertension Survival Analysis 10020 Clinic for Cardiac Surgery Transplantation 030228 respiratory system ROC Curve 2740 Pulmonary and Respiratory Medicine Heart failure Surgery business |
| Popis: | OBJECTIVES: In heart transplant recipients, elevated mean pulmonary artery pressure (mPAP) shortly before or after transplantation represents a powerful predictor for an adverse short-term outcome. Less is known on cardiac and pulmonary pressures measured in the stable phase after heart transplantation. The aim of this study was to assess the predictive value of mPAP, mean pulmonary capillary wedge pressure and mean central venous pressure in the stable phase after transplantation. METHODS: All patients ( n = 260, mean age 47.4 ± 12.7 years, 224 males) who received a cardiac allograft at the University Hospital Zurich between September 1985 and August 2014 and who had undergone at least 1 right heart catheterization after transplantation (median 358 days after transplantation) were included and survival analysis was performed (median follow-up 11.9 years). RESULTS: The median mPAP, mean pulmonary capillary wedge pressure and mean central venous pressure were 15 mmHg (interquartile range 12-19 mmHg), 8 mmHg (interquartile range 6-11 mmHg) and 3 mmHg (interquartile range 1-5 mmHg), respectively. In mPAP median split survival analysis, patients with an mPAP above the median had a significantly lower long-term survival than patients with or below median mPAP ( P = 0.012). mPAP but not mean central venous pressure or mean pulmonary capillary wedge pressure was independently associated with long-term mortality in multivariable Cox-hazard survival analysis (hazard ratio 1.10, confidence interval 1.04-1.16, P = 0.001). Other factors independently associated with mortality were age at transplantation (hazard ratio 1.03 per year, confidence interval 1.01-1.04, P = 0.002) and serum creatinine (μmol/l) (hazard ratio 1.003, confidence interval 1.001-1.010, P = 0.021). CONCLUSIONS: Our results demonstrate that mPAP measured in the stable phase after heart transplantation is an independent prognostic factor for long-term mortality. |
| Databáze: | OpenAIRE |
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