Abstract
BackgroundThere is no generally accepted comprehensive risk prediction model cooperating risk factors associated with heart failure and pulmonary hemodynamics for patients with pulmonary hypertension due to left heart disease (PH-LHD). We aimed to explore outcome correlates and evaluate incremental prognostic value of pulmonary hemodynamics for risk prediction in PH-LHD.MethodsConsecutive patients with chronic heart failure undergoing right heart catheterization were prospectively enrolled. The primary endpoint was all-cause mortality. Individual variable selection was performed by machine learning methods. Cox proportional hazards models were conducted to identify the association between variables and mortality. Incremental value of hemodynamics was evaluated based on the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores.ResultsA total of 276 PH-LHD patients were enrolled, with a median follow-up time of 34.7 months. By L1-penalized regression model and random forest approach, diastolic pressure gradient (DPG) and mixed venous oxygen saturation (SvO2) were the hemodynamic predictors most strongly associated with mortality (coefficient: 0.0255 and -0.0176, respectively), with consistent significance after adjusted for SHFM [DPG: HR 1.067, 95% CI 1.024–1.113, P = 0.022; SvO2: HR 0.969, 95% CI 0.953–0.985, P = 0.002] or MAGGIC (DPG: HR 1.069, 95% CI 1.026–1.114, P = 0.011; SvO2: HR 0.970, 95% CI 0.954–0.986, P = 0.004) scores. The inclusion of DPG and SvO2 improved risk prediction compared with using SHFM [net classification improvement (NRI): 0.468 (0.161–0.752); integrated discriminatory index (IDI): 0.092 (0.035–0.171); likelihood ratio test: P < 0.001] or MAGGIC [NRI: 0.298 (0.106–0.615); IDI: 0.084 (0.033–0.151); likelihood ratio: P < 0.001] scores alone.ConclusionIn PH-LHD, pulmonary hemodynamics can provide incremental prognostic value for risk prediction.Clinical trial registration: NCT02164526 at https://clinicaltrials.gov.
Highlights
Pulmonary hypertension due to left heart disease (PHLHD), typically characterized by a passive increase in pulmonary artery wedge pressure (PAWP) in response to a backward transmission of elevated left-sided filling pressures, is the most frequent cause of pulmonary hypertension (PH) [1, 2]
Quan et al BMC Cardiovascular Disorders (2022) 22:56 variety of etiology, but it is most common in left ventricular systolic or diastolic dysfunction, which is referred to as heart failure with reduced or preserved ejection fraction (HFrEF or HFpEF) [3, 4].Independent of the left ventricular ejection fraction (LVEF) and stage of heart failure (HF), PH is associated with increased hospitalization and mortality [5]
Several pulmonary hemodynamic variables obtained from right heart catheterization (RHC), which is the gold standard to diagnose PH, have been reported to be prognostic predictors for survival and/or other outcomes, such as transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular pressure (PVR) [5,6,7,8,9,10]
Summary
Pulmonary hypertension due to left heart disease (PHLHD), typically characterized by a passive increase in pulmonary artery wedge pressure (PAWP) in response to a backward transmission of elevated left-sided filling pressures, is the most frequent cause of pulmonary hypertension (PH) [1, 2]. Several pulmonary hemodynamic variables obtained from right heart catheterization (RHC), which is the gold standard to diagnose PH, have been reported to be prognostic predictors for survival and/or other outcomes, such as transpulmonary pressure gradient (TPG), diastolic pressure gradient (DPG) and pulmonary vascular pressure (PVR) [5,6,7,8,9,10]. Their prognostic value is still controversial, which can be attributed to several reasons, such as the diverse study designs, the heterogeneous study cohorts, and the various analyzed covariates [5,6,7,8,9,10]. We aimed to explore outcome correlates and evaluate incremental prognostic value of pulmonary hemodynamics for risk prediction in PH-LHD
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