Open AccessDecreased pulmonary arterial proportional pulse pressure is associated with increased mortality in group 1 pulmonary hypertension
Author(s) -
Mwansa Hunter,
Bilchick Kenneth C.,
Parker Alex M.,
Harding William,
Ruth Benjamin,
Kennedy Jamie L. W.,
Mysore Manu,
Kwon Younghoon,
Mihalek Andrew,
Mazimba Sula
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22752
Subject(s) - medicine , quartile , proportional hazards model , hazard ratio , confidence interval , pulse pressure , cardiology , pulmonary hypertension , blood pressure , covariate , statistics , mathematics
Background This study evaluated the utility of a novel index, pulmonary arterial (PA) proportional pulse pressure (PAPP; range 0–1, defined as [PA systolic pressure – PA diastolic pressure] / PA systolic pressure), in predicting mortality in patients with World Health Organization group 1 pulmonary hypertension (PH). Hypothesis Low PAPP is associated with increased 5‐year mortality independent of a validated contemporary risk‐prediction equation (Pulmonary Hypertension Connection [PHC] equation). Methods In a group of 262 patients in the National Institutes of Health Primary Pulmonary Hypertension (NIH‐PPH) Registry, PAPP and the PHC risk equation were used to predict mortality during 5 years of follow‐up using Cox proportional hazards models. Kaplan–Meier survival curves were used to compare mortality among PAPP quartiles, and significance was tested using the log‐rank test. Results Patients in the lowest quartile (PAPP ≤0.47) had a significantly higher 5‐year mortality than did patients in higher quartiles (log‐rank P = 0.016). In a Cox model adjusted for the PHC equation, PAPP remained significantly associated with 5‐year mortality (hazard ratio: 0.74 per 0.10 increase in PAPP, 95% confidence interval: 0.61‐0.90). The χ 2 statistic for the single PAPP covariate in this model was 8.8 ( P = 0.003), which compared favorably with the χ 2 statistic of 15.2 ( P < 0.0001) for the multivariable PHC equation. Conclusions PAPP, an index of ventricular‐arterial coupling, is independently associated with survival in World Health Organization group 1 PH. The use of this easily measurable index for guiding risk stratification needs further investigation.