Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
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DOI：
10.1161/circulationaha.115.020207
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发表时间：
2016-03-29
期刊：
影响因子：
37.8
通讯作者：
Choudhary G
中科院分区：
文献类型：
--
作者：
Maron BA;Hess E;Maddox TM;Opotowsky AR;Tedford RJ;Lahm T;Joynt KE;Kass DJ;Stephens T;Stanislawski MA;Swenson ER;Goldstein RH;Leopold JA;Zamanian RT;Elwing JM;Plomondon ME;Grunwald GK;Barón AE;Rumsfeld JS;Choudhary G
肺动脉高压（PH）与整个心肺疾病谱的发病率增加相关。主要基于专家共识，PH定义为平均肺动脉压（mPAP）≥25 mmHg。尽管mPAP水平低于该阈值在PH风险人群中很常见，但mPAP <25 mmHg与临床结局的相关性尚不清楚。我们回顾性分析了退伍军人事务部医疗保健系统中接受右心导管插入术（RHC）（2007-2012）的所有美国退伍军人（N= 21，727;中位随访时间为908天）。考克斯比例风险模型用于评估mPAP与全因死亡率和住院治疗结局之间的相关性，并对临床协变量进行了校正。当将mPAP作为连续变量处理时，死亡风险从19 mmHg（HR=1.183，95% CI [1.004-1.393]）开始相对于10 mmHg增加。因此，将患者分为三组：参考组（≤18 mmHg; N= 4，207）、临界PH组（19-24 mmHg; N= 5，030）和PH组（≥25 mmHg; N= 12，490）。与参考组相比，临界PH（HR=1.23，95% CI [1.12-1.36]，P<0.0001）和PH（HR=2.16，95% CI [1.96-2.38]，P<0.0001）的校正死亡风险增加。在临界PH（HR=1.07，95% CI [1.01-1.12]，P=0.0149）和PH（HR=1.15，95% CI [1.09-1.22]，P<0.0001）中，住院的校正风险也增加。在排除以下高危亚组后，临界PH队列的死亡风险仍然增加：肺动脉楔压>15 mmHg、肺血管阻力≥3.0 Wood单位或RHC时住院患者。这些数据说明了根据mPAP水平的连续风险，并且临界PH与死亡率和住院率增加相关。未来的研究需要测试我们的发现对其他人群的普遍性，并研究治疗对边缘性PH结局的影响。
Pulmonary hypertension (PH) is associated with increased morbidity across the cardiopulmonary disease spectrum. Based largely on expert consensus opinion, PH is defined by a mean pulmonary artery pressure (mPAP) ≥25 mmHg. Although mPAP levels below this threshold are common among populations at risk for PH, the relevance of mPAP <25 mmHg to clinical outcome is unknown. We analyzed retrospectively all US veterans undergoing right heart catheterization (RHC)(2007–2012) in the Veterans Affairs health care system (N=21,727; 908 day median follow-up). Cox proportional hazards models were used to evaluate the association between mPAP and outcomes of all-cause mortality and hospitalization, adjusted for clinical covariates. When treating mPAP as a continuous variable, the mortality hazard increased beginning at 19 mmHg (HR=1.183, 95% CI [1.004–1.393]) relative to 10 mmHg. Therefore, patients were stratified into three groups: referent (≤18 mmHg; N=4,207), borderline PH (19–24 mmHg; N=5,030), and PH (≥25 mmHg; N=12,490). The adjusted mortality hazard was increased for borderline PH (HR=1.23, 95% CI [1.12–1.36], P<0.0001) and PH (HR=2.16, 95% CI [1.96–2.38], P<0.0001) compared to the referent group. The adjusted hazard for hospitalization was also increased in borderline PH (HR=1.07, 95% CI [1.01–1.12], P=0.0149) and PH (HR=1.15, 95% CI [1.09–1.22], P<0.0001). The borderline PH cohort remained at increased risk for mortality after excluding the following high-risk subgroups: patients with pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance ≥3.0 Wood units, or inpatient status at the time of RHC. These data illustrate a continuum of risk according to mPAP level, and that borderline PH is associated with increased mortality and hospitalization. Future investigations are needed to test the generalizability of our findings to other populations and study the effect of treatment on outcome in borderline PH.
影响因子：
2.6
作者：
Kingrey JF;Panos RJ;Ying J;Meganathan K;Vandivier R;Elwing JM
通讯作者：
Elwing JM