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https://hdl.handle.net/2440/138872
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Type: | Journal article |
Title: | Threshold of Pulmonary Hypertension Associated With Increased Mortality |
Author: | Strange, G. Stewart, S. Celermajer, D.S. Prior, D. Scalia, G.M. Marwick, T.H. Gabbay, E. Ilton, M. Joseph, M. Codde, J. Playford, D. |
Citation: | Journal of the American College of Cardiology, 2019; 73(21):2660-2672 |
Publisher: | ELSEVIER SCIENCE INC |
Issue Date: | 2019 |
ISSN: | 0735-1097 1558-3597 |
Statement of Responsibility: | Geoff Strange, Simon Stewart, David S. Celermajer, David Prior, Gregory M. Scalia, e Thomas H. Marwick, Eli Gabbay, Marcus Ilton, Majo Joseph, Jim Codde, David Playford, on behalf of the NEDA Contributing Sites |
Abstract: | Background: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. Objectives: The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n ¼ 313,492). Methods: The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). Results: The cohort comprised 74,405 men and 83,437 women 65.6 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe ($60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73; 95% confidence interval: 8.60 to 11.0; p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg; hazard ratio: 1.410; 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg; hazard ratio: 1.979; 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p < 0.001) than those in the lowest quintile. Accordingly, a clear and consistent threshold of increased mortality (including 1- and 5-year actuarial mortality) around an eRVSP of 30.0 mm Hg was evident. Conclusions: In this large and unique cohort, the prognostic impact of clinically accepted levels of PHT was confirmed. Moreover, a distinctly lower threshold for increased risk for mortality (eRVSP >30.0 mm Hg) indicative of PHT was identified. |
Keywords: | cohort; mortality; pulmonary hypertension |
Rights: | © 2019 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved. |
DOI: | 10.1016/j.jacc.2019.03.482 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1055214 |
Published version: | http://dx.doi.org/10.1016/j.jacc.2019.03.482 |
Appears in Collections: | Medicine publications |
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