Invasive Hemodynamic Indices That Are Associated with Mortality at One Year in Patients with Pulmonary Hypertension Per Newly Proposed Criteria
Johnson SC, Ali SA, Shah CD, Arman HE, Nabrzyski R, Elsemesmani HI, Gandy R, Wong D, Gibbawi MA, Omar HR, Siddegowda Bangalore B, Duncan M, and Guglin M. Invasive Hemodynamic Indices That Are Associated with Mortality at One Year in Patients with Pulmonary Hypertension Per Newly Proposed Criteria. J Heart Lung Transplant 2023; 42(4):S371-S372.
J Heart Lung Transplant
Purpose: Pulmonary Hypertension (PH) is classified by hemodynamics and etiology. The majority of prognostic factors reported for PH are categorized by etiology. We aimed to study universal prognostic factors in PH irrespective of etiology and solely based on hemodynamics. Additionally, we compared outcomes of different hemodynamic groups. The 6th World Symposium on Pulmonary Hypertension proposed a mean pulmonary arterial pressure (mPAP) >20mmhg which has introduced a new group of patients.
Methods: We retrospectively reviewed 649 consecutive PH patients. PH was defined as any patient with mean pulmonary arterial pressure (mPAP) > 20mmHg. All patients with PH were further categorized into 4 groups based on invasive hemodynamics (Table 1). We used one-way ANOVA to compare groups, Pearson chi-square for categorical analysis, and t-test analysis to compare different hemodynamic parameters within each group.
Results: Out of 649 patients with PH, 137 patients were classified as PH1, 289 as PH2, 141 as PH3, and 76 as PH4. We found that mean right atrial pressure (mRAP), pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), pulmonary capillary wedge pressure (PCWP), mPAP (p < 0.01), and peripheral vascular resistance (PVR) (p<0.05) were universally predictive of increased risk of one-year mortality across all the hemodynamic groups. In our cohort of patients, pulmonary artery pulsatility index (PAPI) was not found to be predictive of one-year mortality (p = 0.52). Lastly, we found that combined death and cardiovascular outcomes at one year were worse for PH3 compared to PH1 and PH4 (p < 0.01).
Conclusion: Our study found that postcapillary pulmonary hypertension is the most prevalent type in our unselected sample of consecutive patients meeting the criteria for PH. Elevated mRAP, PASP, PADP, PCWP, mPAP, and PVR were associated with an increased risk of one-year mortality in the whole cohort. Combined PH had the highest one-year mortality.