Abstract
The prognostic value of pulmonary hypertension (PH) estimated by echocardiography in unselected patients with acute decompensated heart failure (ADHF) is poorly studied. Between November 2014 and September 2018, 657 patients were recruited in a prospective registry of ADHF (ClinicalTrials.gov NCT02444416). The probability of pulmonary hypertension was based on European Society of Cardiology (ESC) guidelines for echocardiographic evaluation. The median survival without all-cause mortality or readmission was 7 months. During the median follow-up period of 15 months, there were 450 events including 185 deaths. In multivariate analysis, the hazard ratio (HR) of all-cause mortality or readmission for patients with a high probability of PH was 1.67 (95% CI 1.29–2.17, p < 0.001) as compared to patients with a low or intermediate probability. The left ventricular ejection fraction (LVEF) and right ventricular function (RVF) were not associated with the primary outcome—HR 1.02 (95% CI 0.81–1.29; p = 0.84) and 0.96 (95% CI 0.76–1.23; p = 0.77) respectively. In patients admitted for ADHF, a high probability of PH as evaluated by echocardiography provided the highest independent prognostic value for mortality and readmission, whereas LVEF and RVF were not associated with prognosis. The identification of patients at high risk of PH by non-invasive measurement conveys important prognostic information and may guide management.
Highlights
Despite the availability of numerous therapeutic agents and advances in patient management, prognosis remains poor in heart failure (HF) [1,2]
The added prognostic value of right ventricular function (RVF) and pulmonary artery pressure (PAP) has been evaluated in chronic HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), but with diagnostic techniques seldom available in standard management settings of patients admitted with acute decompensated heart failure (ADHF) [13,14,15,16,17,18,19]
RVF is sensitive to afterload and its prognostic value may be intimately linked to PAP and to pulmonary hypertension (PH) [14,19]
Summary
Despite the availability of numerous therapeutic agents and advances in patient management, prognosis remains poor in heart failure (HF) [1,2]. The prognostic value of pulmonary hypertension (PH) as estimated by echocardiography in unselected patients with acute decompensated heart failure (ADHF) has previously been addressed in small or pilot studies with
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