Abstract 17584: Pulmonary Artery Systolic Pressure Independently Predicts All-Cause Mortality in Patients with Coronary Artery Disease Irrespective of a Diagnosis of Heart Failure

Abstract

Background: Elevated pulmonary artery systolic pressure (PASP) is associated with a worse outcome in heart failure (HF), but the prognostic role of PASP in patients with coronary artery disease (CAD) remains unknown. Methods: 863 patients with known or suspected CAD (age: 64±13 years, 62% male) enrolled in the Emory Cardiovascular Biobank were followed for a median 455 days for all-cause death. Transthoracic echocardiographic parameters included measurement of left ventricular ejection fraction (LVEF, range: 5-80%) and diastolic function parameters. Youden’s index from the receiver operating curve analysis was used to determine the best discriminatory cutoff for PASP (cutoff=43 mmHg). Cox regression was performed to determine independent predictors of mortality. Results: 88 (10%) subjects died during follow-up. PASP correlated with left ventricular ejection fraction (LVEF, N=644, r=-0.20, p<0.0001), C-reactive protein (CRP, N=539, r=0.12, p=0.004), and mitral valve inflow E/A ratio (N=359, r=0.32, p<0.0001), mitral valve deceleration time (N=260, r=-0.16, p=0.007),and left atrial size (LAs, N=694, r=0.25, p<0.0001). High PASP predicted incident mortality in a model adjusted for age, gender, diabetes, hypertension, dyslipidemia, smoking, glomerular filtration rate, CRP, heart failure, Gensini angiographic severity score, as well as aspirin, statin, beta-blocker, and angiotensin converting enzyme-inhibitor use (HR: 3.3, p=0.000001). The association of PASP with death was independent of LVEF (HR=3.2, p=0.00002). Thus, high PASP also predicted mortality in subjects with LVEF>50% and no history of HF (HR: 4.7, p=0.004). In separate models, this association was also independent of LAs and E/A. Conclusion: High PASP >43 mmHg is an independent predictor of mortality in patients with CAD even in those with preserved LVEF without HF. Whether high PASP predicts future development of HF and hospitalization for HF exacerbation needs to be investigated.