Elevated pulmonary artery systolic pressure predicts heart failure admissions in African Americans: Jackson Heart Study.
Elevated pulmonary artery systolic pressure predicts heart failure admissions in African Americans: Jackson Heart Study.
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DOI：
10.1161/circheartfailure.114.001366
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发表时间：
2014-07
期刊：
影响因子：
--
通讯作者：
Wu WC
中科院分区：
文献类型：
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作者：
Choudhary G;Jankowich M;Wu WC
虽然肺动脉收缩压（PASP）升高与心力衰竭（HF）相关，但PASP测量是否有助于预测未来的HF入院尚不清楚，特别是在HF风险增加的非洲裔美国人中。我们假设，在非裔美国人（AA）人群中，PASP升高与HF入院风险增加相关，并改善HF预测。我们使用JHS队列（n=3125，32.2%男性）进行了纵向分析，基线回声衍生PASP和随访HF入院。使用Cox比例风险模型（针对社区动脉粥样硬化风险（ARIC）HF预测模型中的变量进行调整）估计HF入院的风险比。中位随访时间为3.46年，队列中3.42%的人因心力衰竭入院。HF受试者的PASP较高（35.6 ± 11.4 mm Hg vs. 27.6 ± 6.9 mm Hg，p<0.001）。HF入院风险随基线PASP升高而增加（校正的HR/10 mmHg PASP增加：2.03，95% CI：1.67-2.48;校正的HR最高（≥33 mmHg）与最低四分位数（<24 mmHg）PASP：2.69，95% CI：1.43-5.06），并且无论HF病史或射血分数保留/降低如何，均保持显著性。将PASP添加到ARIC模型中导致模型辨别力的显著改善（AUC = 0.82之前vs. 0.84之后，p = 0.03），并改善了净重新分类指数（11-15%），使用PASP作为连续或二分（截止值：33 mm Hg）变量。升高的PASP可预测非裔美国人的HF入院，并有助于早期识别有风险的受试者进行积极的风险因素调整。
While elevated pulmonary artery systolic pressure (PASP) is associated with heart failure (HF), whether PASP measurement can help predict future HF admissions is not known, especially in African-Americans, who are at increased risk for HF. We hypothesized that elevated PASP is associated with increased risk of HF admission and improves HF prediction in African-American (AA) population. We conducted a longitudinal analysis using the JHS cohort (n=3125, 32.2% men) with baseline echo-derived PASP and follow-up for HF admissions. Hazard ratio for HF admission was estimated using Cox-proportional hazard model adjusted for variables in the Atherosclerosis Risk in Community (ARIC) HF prediction model. Over median follow up of 3.46 years, 3.42% of the cohort was admitted for HF. Subjects with HF had a higher PASP (35.6 ± 11.4 mm Hg vs. 27.6 ± 6.9 mm Hg, p<0.001). The hazard of HF admission increased with higher baseline PASP (adjusted HR/10 mmHg increase in PASP: 2.03, 95% CI: 1.67-2.48; adjusted HR for highest (≥33 mmHg) versus lowest quartile (<24 mmHg) of PASP: 2.69, 95% CI: 1.43-5.06) and remained significant irrespective of history of HF, or preserved/reduced ejection fraction. Addition of PASP to the ARIC model resulted in a significant improvement in model discrimination (AUC = 0.82 before vs. 0.84 after, p = 0.03), and improved net reclassification index (11-15%), using PASP as a continuous or dichotomous (cutoff: 33 mm Hg) variable. Elevated PASP predict HF admissions in African Americans and may aid in early identification of at risk subjects for aggressive risk factor modification.