The Association Between Pulmonary Vascular Resistance and Clinical Outcomes in Patients with Pulmonary Hypertension: A Retrospective Cohort Study
Abstract
Background: In pulmonary hypertension (PH) subgroups, elevated pulmonary vascular resistance (PVR) ≥3.0 WU is associated with poor prognosis. However, the spectrum of PVR risk in PH is not known. To address this area of uncertainty, we aimed to analyze the relationship between PVR and adverse clinical outcomes in PH. Methods: We analyzed retrospectively all patients undergoing right heart catheterization (RHC) in the Veterans Affairs healthcare system (2008–2016; 1,153 [570–1,971] days median follow-up). Cox proportional hazards models were used to assess the association between PVR and outcomes, and the mortality hazard was validated in a RHC cohort from Vanderbilt University Medical Center (1998–2014; 1,752 [1,281–2,999] days median follow-up). Findings: The primary cohort (N=40,082; male, N=38,751 [96.7%]; 66.5 [61.1–73.5] yr) included patients with a history of heart failure (N=23,201 [57.9%]) and chronic obstructive pulmonary disease (N=13,348 [33.3%]). We focused on patients at risk for PH based on mean pulmonary artery pressure (mPAP) ≥19 mmHg (N=32,725 of 40,082 [81.6%]). When modeled as a continuous variable, the all-cause mortality hazard for PVR was increased at ~2.2 WU compared to PVR=1.0 WU. Among patients with ≥19 mmHg and pulmonary artery wedge pressure ≤15 mmHg, the adjusted hazard ratios for mortality and heart failure hospitalization were 1.71 (95% CI: 1.59–1.84, P<0.0001) and 1.27 (95% CI: 1.13–1.43, P=0.0001), respectively, when comparing PVR ≥2.2 WU to…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 40,082 participants or records.
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