Heart Care Info - Heart Disease Prevention & Treatment

Pulmonary Pressures and Death in Heart Failure: A Community Study

F Bursi, SM Mc Nallan, MM Redfield... - Journal of the ..., 2012 - Am Coll Cardio Found 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 ...

Francesca Bursi, MD, M Sc*,, Sheila M. Mc Nallan, MPH, Margaret M. Redfield, MD*, Vuyisile T. Nkomo, MD, MPH*, Carolyn S.P. Lam, MBBS*,,||, Susan A. Weston, MS, Ruoxiang Jiang, BS and V ronique L. Roger, MD, MPH*,,*

* Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota Policlinico University Hospital of Modena, Modena, Italy National University Health System, Singapore

|| Boston University School of Medicine, Boston, Massachusetts

Manuscript received December 12, 2010; revised manuscript received June 20, 2011, accepted June 28, 2011.

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.

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.

Key Words: community heart failure mortality pulmonary hypertension