Document Detail


Relationship between reactive pulmonary hypertension and mortality in patients with acute decompensated heart failure.
MedLine Citation:
PMID:  21606213     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with heart failure, pulmonary hypertension (PH) predicts higher risk for morbidity and mortality. However, few data are available on the prognostic implications of reactive (precapillary) PH superimposed on passive (postcapillary) PH.
METHODS AND RESULTS: We performed a subgroup analysis of 242 patients with acute decompensated heart failure assigned to pulmonary artery catheter placement in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Patients were classified into 3 groups, using the final (posttreatment) hemodynamic measurements: (1) no PH (mean pulmonary artery pressure ≤ 25 mm Hg; (2) passive PH (mean pulmonary artery pressure > 25, pulmonary capillary wedge pressure >15 mm Hg, and pulmonary vascular resistance ≤ [corrected] Wood units); and (3) reactive PH (mean pulmonary artery pressure > 25, [corrected] pulmonary capillary wedge pressure >15 mm Hg, and pulmonary vascular resistance > 3 Wood units). Fifty-eight patients were classified as normal mean pulmonary artery pressure, 124 with passive PH and 60 with reactive PH. During follow-up of 6 months, 5 (8.6%), 27 (21.8%), and 29 (48.3%) deaths occurred in patients without PH, patients with passive PH, and with reactive PH, respectively (P<0.0001). After multivariable adjustments, reactive PH remained an independent predictor of death, with an adjusted hazard ratio of 4.8 compared with patients without PH, and 2.8 compared with patients with passive PH (95% confidence interval, 1.7 to 4.7, P=0.0001). Similar results were obtained when reactive PH was defined on the basis of transpulmonary gradient.
CONCLUSIONS: Reactive PH is common among patients with acute decompensated heart failure after initial diuretic and vasodilator therapy. The adverse outcome associated with PH is predominantly due to increased mortality rates in the subgroup of patients with reactive PH.
Authors:
Doron Aronson; Amnon Eitan; Robert Dragu; Andrew J Burger
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2011-05-23
Journal Detail:
Title:  Circulation. Heart failure     Volume:  4     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-21     Completed Date:  2011-12-13     Revised Date:  2012-02-22    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  644-50     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Rambam Medical Center, Haifa, Israel. daronson@tx.technion.ac.il
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Blood Pressure / physiology
Diuretics / therapeutic use
Female
Follow-Up Studies
Heart Failure / drug therapy,  epidemiology*,  mortality*
Humans
Hypertension, Pulmonary / complications*,  physiopathology*
Male
Middle Aged
Predictive Value of Tests
Prognosis
Pulmonary Wedge Pressure / physiology
Risk Factors
Survival Rate
Vascular Resistance / physiology
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Diuretics; 0/Vasodilator Agents
Comments/Corrections
Comment In:
Circ Heart Fail. 2011 Sep;4(5):541-5   [PMID:  21934090 ]
Erratum In:
Circ Heart Fail. 2012 Jan 1;5(1):e18

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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