Threshold of Pulmonary Hypertension Associated With Increased Mortality

Geoff Strange; Simon Stewart; David S Celermajer; David Prior; Gregory M Scalia; Thomas H Marwick; Eli Gabbay; Marcus Ilton; Majo Joseph; Jim Codde; David Playford; NEDA Contributing Sites

doi:10.1016/j.jacc.2019.03.482

Threshold of Pulmonary Hypertension Associated With Increased Mortality

J Am Coll Cardiol. 2019 Jun 4;73(21):2660-2672. doi: 10.1016/j.jacc.2019.03.482.

Authors

Affiliations

¹ University of Notre Dame, Fremantle, Western Australia, Australia. Electronic address: gstrange@neda.net.au.
² University of Cape Town, Cape Town, South Africa.
³ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁴ University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
⁵ University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁶ Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
⁷ University of Notre Dame, Fremantle, Western Australia, Australia.
⁸ Menzies School of Health Research, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
⁹ Flinders University, Adelaide, South Australia, Australia.

PMID: 31146810
DOI: 10.1016/j.jacc.2019.03.482

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 = 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. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index; ACTRN12617001387314).

Keywords: cohort; mortality; pulmonary hypertension.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Australia / epidemiology
Cohort Studies
Female
Humans
Hypertension, Pulmonary / diagnosis
Hypertension, Pulmonary / mortality*
Male
Middle Aged
Prognosis
Young Adult