Elevated pulmonary artery pressure: An independent predictor of mortality

Document Type

Article

Publication Date

1-1-1991

Abstract

Analyses in this study were based on hemodynamic and angiographic data obtained in a cohort of 1,371 predominantly black patients during right and left heart catheterization. All patients were followed up prospectively for a mean of 117 weeks, and 103 fatal events were recorded. In Cox survival analysis, three variables were found to be independently related to survival: pulmonary artery mean pressure (PAMP), number of stenosed vessels, and left ventricular (LV) ejection fraction (p<0.01); in multivariate stepwise analysis, PAMP entered the model first with the largest χ2 value of three prognostic variables (χ2=33.4; p<0.0001). The PAMP was 32 percent higher in decedents compared with survivors (25+11 mm Hg vs 19+8 mm Hg, p<0.01 [mean, SD]) and a 10 mm Hg increase in PAMP was associated with a more than fourfold increase in the relative risk of dying; this finding was independent of pulmonary vascular resistance and therefore could not be attributed to primary pulmonary vascular or parenchymal disease. In both the subgroup of 1,118 patients with a normal LV ejection fraction (>50 percent) and the 253 patients with a reduced ejection fraction (<50 percent), PAMP emerged as an independent predictor of mortality (p<0.0001 and 0.01, respectively), and is therefore a marker of cardiac disease beyond impairment of systolic contractile function. Among patients without obstructive coronary artery disease, PAMP alone provided prognostic information in the multivariate survival analysis.

Publication Source (Journal or Book title)

Chest

First Page

112

Last Page

120

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