| Pulmonary pressures and death in heart failure: a community study. | |
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MedLine Citation:
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PMID: 22240126 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The purpose of this study was to determine among community patients with heart failure (HF) whether pulmonary artery systolic pressure (PASP) assessed by Doppler echocardiography was associated with death and improved risk prediction over established factors, using the integrated discrimination improvement and net reclassification improvement. BACKGROUND: Although several studies have focused on idiopathic pulmonary arterial hypertension, less is known about pulmonary hypertension among patients with HF, particularly about its prognostic value in the community. METHODS: Between 2003 and 2010, Olmsted County residents with HF prospectively underwent assessment of ejection fraction, diastolic function, and PASP by Doppler echocardiography. RESULTS: PASP was recorded in 1,049 of 1,153 patients (mean age 76 ± 13; 51% women). Median PASP was 48 mm Hg (25th to 75th percentile: 37.0 to 58.0). There were 489 deaths after a follow-up of 2.7 ± 1.9 years. There was a strong positive graded association between PASP and mortality. Increasing PASP was associated with an increased risk of death (hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 1.13 to 1.85 for tertile 2; HR: 2.07, 95% CI: 1.62 to 2.64 for tertile 3 vs. tertile 1), independently of age, sex, comorbidities, ejection fraction, and diastolic function. Adding PASP to models including these clinical characteristics resulted in an increase in the c-statistic from 0.704 to 0.742 (p = 0.007), an integrated discrimination improvement gain of 4.2% (p < 0.001), and a net reclassification improvement of 14.1% (p = 0.002), indicating that PASP improved prediction of death over traditional prognostic factors. All results were similar for cardiovascular death. CONCLUSIONS: Among community patients with HF, PASP strongly predicts death and provides incremental and clinically relevant prognostic information independently of known predictors of outcomes. |
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Authors:
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Francesca Bursi; Sheila M McNallan; Margaret M Redfield; Vuyisile T Nkomo; Carolyn S P Lam; Susan A Weston; Ruoxiang Jiang; Véronique L Roger |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 59 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-13 Completed Date: 2012-02-27 Revised Date: 2012-04-24 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 222-31 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Cardiovascular Diseases, Department of Internal Medicine, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Cohort Studies Female Follow-Up Studies Heart Failure / mortality*, physiopathology* Humans Hypertension, Pulmonary / mortality*, physiopathology* Male Middle Aged Population Surveillance / methods Prospective Studies Pulmonary Wedge Pressure / physiology* Residence Characteristics* |
| Grant Support | |
ID/Acronym/Agency:
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R01 AG034676/AG/NIA NIH HHS; R01 AG034676/AG/NIA NIH HHS; R01 AG034676-46/AG/NIA NIH HHS; R01 AG034676-47/AG/NIA NIH HHS; R01 HL059205-13/HL/NHLBI NIH HHS; R01 HL059205-14/HL/NHLBI NIH HHS; R01 HL072435-08/HL/NHLBI NIH HHS; R01 HL59205/HL/NHLBI NIH HHS; R01 HL72435/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2012 Jan 17;59(3):232-4
[PMID:
22240127
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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