Pulmonary pressures and death in heart failure: a community study.
Pulmonary pressures and death in heart failure: a community study.
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心力衰竭中的肺部压力和死亡：社区研究。
DOI：
10.1016/j.jacc.2011.06.076
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发表时间：
2012-01-17
影响因子：
24
通讯作者：
Roger, Veronique L.
中科院分区：
文献类型：
--
作者：
Bursi, Francesca;McNallan, Sheila M.;Redfield, Margaret M.;Nkomo, Vuyisile T.;Lam, Carolyn S. P.;Weston, Susan A.;Jiang, Ruoxiang;Roger, Veronique L.
在社区心力衰竭（HF）患者中，通过多普勒超声心动图评估肺动脉收缩压（PASP）是否与死亡相关，并使用综合区分改善（IDI）和净重新分类改善（NRI）来确定风险预测是否优于既定因素。虽然一些研究集中在特发性肺动脉高压，但对HF患者的肺动脉高压知之甚少，特别是其在社区中的预后价值。2003年至2010年间患有心力衰竭的奥姆斯特德县居民前瞻性地接受了多普勒超声心动图评估射血分数（EF）、舒张功能和PASP。1153例患者中有1049例记录到PASP（平均年龄76±13岁，51%为女性）。中位PASP为48 mmHg（第25 - 75百分位数，37.0-58.0）。随访2.7±1.9年后，有489例死亡。PASP和死亡率之间存在很强的正相关。PASP增加与死亡风险增加相关（HR 1.45，95%CI 1.13-1.85，三分位数2; HR 2.07，95%CI 1.62-2.64，三分位数3，与三分位数1相比），与年龄、性别、合并症、EF和舒张功能无关。将PASP添加到包括这些临床特征的模型中，导致c统计量从0.704增加到0.742（p=0.007），IDI增加4.2%（p<0.001），NRI为14.1%（p=0.002），表明PASP比传统预后因素改善了死亡预测。CV死亡的所有结果均相似。在社区HF患者中，PASP可强有力地预测死亡，并提供独立于已知结局预测因素的增量和临床相关预后信息。
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 (IDI) and net reclassification improvement (NRI). While several studies have focused on idiopathic pulmonary arterial hypertension, less is known about pulmonary hypertension among patients with HF, particularly on its prognostic value in the community. Olmsted County residents with HF between 2003 and 2010 prospectively underwent assessment of ejection fraction (EF), diastolic function, and PASP by Doppler echocardiography. PASP was recorded in 1049 of 1153 patients (mean age 76±13, 51% women). Median PASP was 48 mmHg (25th-75th percentile, 37.0-58.0). 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 (HR 1.45, 95%CI 1.13-1.85 for tertile 2; HR 2.07, 95%CI 1.62-2.64 for tertile 3, versus tertile 1), independently of age, sex, comorbidities, EF 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 IDI gain of 4.2% (p<0.001), and an NRI of 14.1% (p=0.002), indicating that PASP improved prediction of death over traditional prognostic factors. All results were similar for CV death. Among community patients with HF, PASP strongly predicts death and provides incremental and clinically relevant prognostic information independently of known predictors of outcomes.
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影响因子：
8.9
作者：
Capomolla, S;Febo, O;Cobelli, F
通讯作者：
Cobelli, F
DOI：
10.1016/0735-1097(93)90455-a
发表时间：
1993-10-01
影响因子：
24
作者：
HO, KKL;PINSKY, JL;LEVY, D
通讯作者：
LEVY, D
影响因子：
3.5
作者：
Neuman, Yoram;Kotliroff, Andy;Lishner, Michael
通讯作者：
Lishner, Michael
影响因子：
24
作者：
Lam, Carolyn S. P.;Roger, Veronique L.;Rodeheffer, Richard J.;Borlaug, Barry A.;Enders, Felicity T.;Redfield, Margaret M.
通讯作者：
Redfield, Margaret M.
影响因子：
120.7
作者：
Bursi, Francesca;Weston, Susan A.;Roger, Veronique L.
通讯作者：
Roger, Veronique L.