Impact Of Pulmonary Hypertension Research Articles

B-60 | Impact of Pulmonary Hypertension on Long-Term Outcome After Transcatheter Mitral Valve Replacement: A Meta- Analysis

B-60 | Impact of Pulmonary Hypertension on Long-Term Outcome After Transcatheter Mitral Valve Replacement: A Meta- Analysis

C-1 | "The Impact of Pulmonary Hypertension on Survival in Carcinoid Heart Disease: Insights from Invasive Hemodynamic Assessment"

C-1 | "The Impact of Pulmonary Hypertension on Survival in Carcinoid Heart Disease: Insights from Invasive Hemodynamic Assessment"

Impact of pulmonary hypertension on outcomes after TEER in patients suffering from mitral regurgitation.

Data on associations of invasively determined hemodynamic parameters with procedural success and outcomes in patients suffering from mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair of the mitral valve (M-TEER) is limited. We enrolled 239 patients with symptomatic MR of grade 2 + , who received M-TEER. All patients underwent extensive pre-interventional invasive hemodynamic measurements via right heart catheterization (mean pulmonary arterial pressure (mPAP), systolic- (PAPsys) and diastolic pulmonary arterial pressure (PAPdia), pulmonary arterial wedge pressure (PAWP), a-wave, v-wave, pulmonary vascular resistance (PVR), transpulmonary pressure gradient (TPG), cardiac index (CI), stroke volume index (SVI)). mPAP and PAWP at baseline were neither associated with procedural success, immediate reduction of MR, nor residual MR after 6months of follow-up. The composite outcome (All-cause mortality (ACM) and/or heart failure induced rehospitalization (HFH)) and HFH differed significantly after M-TEER when stratified according to mPAP, PAWP, PAPdia, a-wave and v-wave. ACM was not associated with the afore mentioned parameters. Neither PVR, TPG, CI nor SVI were associated with the composite outcome and HFH, respectively. In multivariable analyses, PAWP was independently associated with the composite outcome and HFH. PVR and SVI were not associated with outcomes. PAWP at baseline was significantly and independently associated with HFH and might serve as a valuable parameter for identifying patients at high risk for HFH after M-TEER. ACM and procedural success were not affected by pulmonary arterial pressure before M-TEER. We suggest that the post-capillary component of PH serves as the driving force behind the risk of HFH.

Impact of pulmonary hypertension on short-term outcomes in patients undergoing surgical aortic valve replacement for severe aortic valve stenosis.

In patients with left heart disease and severe aortic stenosis (AS), pulmonary hypertension (PH) is a common comorbidity and predictor of poor prognosis. Untreated AS aggravates PH leading to an increased right ventricular afterload and, in line to right ventricular dysfunction. The surgical benefit of aortic valve replacement (AVR) in elderly patients with severe AS and PH could be limited due to the multiple comorbidities and poor outcomes. Therefore, we purposed to investigate the impact of PH on short-term outcomes in patients with moderate to severe AS who underwent surgical AVR in our heart center. In this study we retrospectively analyzed a cohort of 99 patients with severe secondary post-capillary PH who underwent surgical AVR (AVR + PH group) at our heart center between 2010 and 2021 with a regard to perioperative outcomes. In order to investigate the impact of PH on short-term outcomes, the control group of 99 patients without pulmonary hypertension who underwent surgical AVR (AVR group) at our heart center with similar risk profile was accordingly analyzed regarding pre-, intra- and postoperative data. Atrial fibrillation occurred significantly more often (p = .013) in patients who suffered from PH undergoing AVR. In addition, the risk for cardiac surgery (EUROSCORE II) was significantly higher (p < .001) in the above-mentioned group. Likewise, cardiopulmonary bypass time (p = .018), aortic cross-clamp time (p = .008) and average operation time (p = .009) were significantly longer in the AVR + PH group. Furthermore, the in-hospital survival rate was significantly higher (p = .044) in the AVR group compared to the AVR + PH group. Moreover, the dialysis rate was significantly higher (p < .001) postoperatively in patients who suffered PH compared to the patients without PH undergoing AVR. In our study, patients with severe PH and severe symptomatic AS who underwent surgical aortic valve replacement showed adverse short-term outcomes compared to patients without PH.

The impact of pulmonary hypertension on early postoperative period after lung transplantation with particular emphasis on kidney function

Abstract Background A special group of lung transplantation (LTx) recipients are patients diagnosed with pulmonary hypertension (PH) in the form of idiopathic pulmonary arterial hypertension (IPAH) or chronic lung diseases associated PH (CLD-PH). Acute left heart failure is a major complication observed in the early post-transplant period of patients with PH. To avoid post-transplant cardiac failure, the following measures may be implemented: use of intraoperative veno-arterial extracorporeal membrane oxygenation, administration of inotropic agents, a restrictive fluid management or use of continuous renal replacement therapy. Although, it remains unclear whether such a therapy affects long-term kidney function and patient survival. Purpose To analyze the influence of pulmonary hypertension diagnosis on early postoperative outcome including deterioration of renal function defined as the change in eGFR that occurred between baseline eGFR and the first and seventh day of observation post-LTx. Methods Retrospective data analysis of 79 patients undergoing lung transplantation in 2015-2018 in our institution with diagnosis of PH. Exclusion criterium was absence of 7 days observation post LTx or lack of PH diagnosis. The comparison of pre- and postoperative data was performed between IPAH (N=7) and CLD-PH (N=43) patients. Results We found differences in preoperative serum creatinine levels between IPAH and CLD-PH group (109,5 umol/l (70-126) vs 62,3 umol/l (49,3-73,4), respectively), p&amp;lt;0.05. The greatest decline of eGFR in the early postoperative period was demonstrated on day 7 in both groups (ΔeGFR=42,2±6,7 for CLD-PH group and 56,5±9,8 for IPAH group). Patients did not differ according to age, sex and BMI values. In IPAH group operation tend to last longer (657,9±78,2 min vs 539,6±111,6 min, p&amp;lt;0.05), all of them were performed with the use of cardiopulmonary bypass. All patients from IPAH group and 95,6% from CLD-PH group received inotropic support during LT procedure and early postoperative days. Duration of mechanical ventilation was statistically shorter among CLD-PH patients (2,9 days (0,8-1,4) vs 6,1 days (3,3-39), p&amp;lt;0.001). Conclusion It seems to be probable that pulmonary hypertension could be significant risk factor of kidney deterioration after lung transplantation. Identification of factors modifying renal insufficiency development in lung transplant recipients needs further investigations.

Abstract 19002: Impact of Pulmonary Hypertension on Covid-19 Pneumonia Hospitalizations: Analysis of The National Inpatient Sample 2020

Background: SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. COVID pneumonia (CP) can result in ARDS and increased pulmonary artery pressures. Pulmonary hypertension (PHT) is generally a chronic cardiopulmonary disease that is associated with progressive vascular remodeling. We aimed to assess the impact of underlying PHT on CP patients with a large sample size. Methods: We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PHT. A multivariate regression model was used to adjust for confounders and analyze the variables. Results: Of those who were admitted for CP, 24,284 (2.3%) had PHT. In-hospital mortality was higher in those with PHT (19.6% vs 10.9%; p&lt;0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PHT had longer length of stay (LOS) by 1.3 days (p&lt;0.001) and had additional hospital costs (HC) of $23,232 (p&lt;0.001). Conclusions: CP patients who had PHT had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, sepsis, cardiogenic shock, and being intubated. These patients are unable to tolerate the ventilation-perfusion mismatch and the rise in pulmonary arterial pressures seen in ARDS.

Impact of pulmonary hypertension on outcomes of influenza pneumonia patients: A nationwide analysis

Background: Pulmonary hypertension can be a significant cause of morbidity and mortality for influenza pneumonia (IP) patients. We performed analysis from the multicentric National Inpatient Sample (NIS) datasets to study the influence of disorders of pulmonary hypertension on the outcomes in IP patients. Methods: We used NIS 2016–2019 to identify IP hospitalizations (between 22–90 years of age) and divided them into with and without pulmonary hypertension (herein PHDPC). We analyzed for differences in demographics, primary (all-cause mortality) and other secondary outcomes. Results: Of 353,460 IP hospitalizations, 6.5% had PHDPC. The PHDPC cohort had more elderly, females, African Americans, and Medicare enrollees predominantly with more hospitalizations to large bed sizes and urban teaching hospitals, and higher cardiovascular comorbidities than non-PHDPC cohort. PHDPC had higher primary outcomes for in-hospital mortality (8.9% vs. 5.8%, adjusted OR 1.4, 95% CI: 1.21–1.61). PHDPC also had higher secondary outcomes for sepsis, septic shock, cardiogenic shock and need for mechanical ventilation, prolonged ventilation, hospital resource utilization for longer mean length of stay, mean hospitalization cost, transfer to other facilities or need for home health care, and high risk for 30-day readmission than the non-PHDPC cohort. Conclusions: With our study, we provide contemporary data for the outcomes of IP inpatients with pulmonary hypertension and depict worse outcomes for mortality, complications, and hospital resource utilization. Although our study does not include stratification for vaccination status for the outcome, primary care physicians, cardiologists, and pulmonologists should pro-actively educate patients on preventive strategies during the flu season.

Mitral Valve Intervention, Pulmonary Hypertension, and Survival in 219 Shone’s Syndrome Patients

BackgroundRelationships among pulmonary hypertension (PHTN), mitral valve intervention (MVI), and death in patients with Shone’s syndrome (SS) are unclear. This study’s recent data suggested temporal progression of mitral valve disease and an early survival benefit with MVI at initial operation. In this expanded cohort, the study characterized the trajectory and impact of PHTN on survival, as well as its relationship with MVIs. MethodsStudy investigators conducted a record review of 219 patients with SS who underwent operation at a quaternary center between 1956 and 2022; 111 of these patients were pediatric (aged <18 years). Patients were determined to have PHTN by using a time-defined hierarchic algorithm consisting of cardiac catheterization data, echocardiographic variables, pulmonary vasodilator therapy, and a record-verified PHTN diagnosis. Analysis included risk-adjusted predicted survival and freedom from PHTN curves stratified by MVI timing. ResultsAmong 219 patients, 92 (43%) had mitral stenosis on presentation, with a mean gradient of 3.5 mm Hg (interquartile range, 4.7 mm Hg). Sixty patients had undergone at least 1 MVI; 23 (9%) patients had 3 or more MVIs. The median follow-up was 19 years (interquartile range, 29 years), and 18 (8%) deaths occurred. Ninety-three (42%) patients had PHTN, with 50% and 25% freedom from PHTN at 37 and 51 years from presentation, respectively. PHTN was strongly associated with death (P < .001). In unadjusted analyses, MVI, even if successive, delayed the onset of PHTN at 10 years and improved survival (P < .001). However, this protective effect was lost after risk adjustment. ConclusionsPHTN development in SS is progressive and mirrors the survival curve, findings suggesting that PHTN is a major mortality risk factor. Salutary effects of early or successive MVI are reduced after risk adjustment.

Impact of Pulmonary Hypertension on Renal Functions in Obstructive Sleep Apnea Syndrome

Pulmonary hypertension (PH) is common in obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the effect of PH on kidney functions in patients with OSAS. The data of patients who were diagnosed as having OSAS after referral to the sleep center in the Gaziantep University Medical Faculty between January 2005 and June 2017 were evaluated. The estimated glomerular filtration rate was calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Renal functions of the subjects who had data after 5 years were included for long-term analysis. A total of 2152 patients with OSAS (n = 1540), PH (n = 49), OSAS and PH coexistence (n = 359), and the control group (n = 204) were included in the study. Pulmonary arterial pressure (PAP) was 44.51 ± 23.73 in the PH group; it was 37.1 ± 13.14 in the group with OSAS + PH (P = 0.001) Urea and uric acid were found to be higher in the association of OSAS + PH. CKD-EPI was lower in the presence of PH or OSAS + PH than in the presence of OSAS. PH was present in 16.06% of males and 25.10% of females (P = 0.000), and PAP was detected as 35.80 ± 13.23 and 40.96 ± 16.65, respectively (P = 0.001). PH was present in 15.99% of males and 25.84% of females with OSAS (P = 0.000). The PAP of males with OSAS was 36.03 ± 13.46, and the PAP of females was 38.68 ± 12.55 (P = 0062). Urea, creatinine, and uric acid were higher and CKD-EPI was lower in male subjects in the presence of OSAS and PH, whereas the same scenario also was present in the presence of PH alone in female subjects. Long-term comparisons (n = 343) revealed significant decreases in the CKD-EPI in those with OSAS and OSAS + PH and these decrease were more pronounced in the presence of OSAS and PH. The regression analysis revealed that female patients had lower CKD-EPI in the presence of PH, although the presence of PH had no effect on CKD-EPI in males. PH is a risk factor for the deterioration of renal function in OSAS and more prominent in the long term.

Abstract 13162: Temporal Trends in Secondary Pulmonary Hypertension and Subsequent Mortality in Hospitalized Geriatric Patients With Prior Revascularized Myocardial Infarction (2016-2019)

Background: There is limited data on the burden and impact of Pulmonary hypertension (PHTN) in geriatric patients with prior revascularized MI. This study aims to explore the burden, trends, and impact of secondary PHTN on the survival of elderly patients with established CVD risk. Methods: We used the National Inpatient Sample (2016-2019) to identify geriatric (≥65 years) hospitalizations with prior revascularized MI (PCI or CABG) by using ICD-10 codes and divided them into two groups: with secondary PHTN and without secondary PHTN (GPRMI-PHTN+ VS. GPRMI-PHTN-). We then compared the two groups' morbidity, mortality, and associated outcomes. Results: Of 2265900 GPRMI patients that were included in the study, 169942 (7.5%) had secondary PHTN (median 76 [70-82]). The PHTN cohort often had females (42.5% vs 33.7%) and blacks (10.8% vs 7.7%) than the cohort without PHTN (p&lt;0.001). The PHTN group often consisted of higher rates of diabetics (49.8% vs 46.3%) and smokers (45% vs 43.9%) (all p&lt;0.005). The PHTN cohort had a higher all-cause mortality rate (3.7% vs 2.6%), often required home health care (26.7% vs 21.3%), transfers to other care facilities (23.4% vs 21.7%), with prolonged hospital stays (median 4 vs 3 days), and had higher hospital costs (all p&lt;0.005). A significant decline in morbidity and mortality was noted temporally among males, females, and whites, but not in black, hispanic, and asian populations. Conclusions: PHTN is strongly associated with morbidity and mortality in geriatric patients with a prior history of revascularized MI. Prospective studies on such patients with long-term follow-up are warranted to establish trends and disparities among different populations and prevent worse outcomes.

Abstract 15879: Impact of Pulmonary Hypertension on In-Hospital Outcomes for Patients Undergoing Typical Atrial Flutter Ablation

Introduction: Pulmonary hypertension (PHT) is a progressive disease with a clinical course characterized by frequent decompensations in advanced stages. Atrial arrhythmias, including typical atrial flutter, are common in patients with PHT. We sought to investigate the effect of presence of pulmonary hypertension to the outcomes after typical atrial flutter ablation. Methods: We utilized the National Inpatient database from 2016 to 2019 to perform this study. By utilizing the ICD-10-CM codes all hospitalizations for typical atrial flutter ablation were identified. Patients with atypical flutter and ablation were excluded. Among these subjects, those with associated diagnosis of pulmonary hypertension (WHO Group 1 to 5) were identified and they formed the study group. Primary outcome was to in-hospital mortality and complications. Secondary outcomes included analysis of patient clinical characteristics, length of hospital stay (LOS) and total hospital charges (TOTCH). Multivariate regression analysis was used to predict outcomes. Results: A total of 7,784 patients with PHT were hospitalized for typical atrial flutter ablation during the study period. Patients with PHT were slightly older (66 vs 67 years, p&lt;0.001). The proportion of males was lower in the PHT group (57vs 67 %, p&lt;0.001). For Typical AFL patients undergoing ablation, the presence of PHT was associated with higher odds of mortality (a0R= 1.8, p=0.003), acute kidney injury (a0R= 1.6, p&lt;0.001), heart failure exacerbation (a0R= 1.3, p&lt;0.001) and cardiogenic shock (a0R= 2.2, p&lt;0.001) on multivariate regression analysis. They also had higher LOS (+2.3 days, p&lt;0.001) and TOTCH (+$30,501, p&lt;0.001). Conclusion: Our data shows that pulmonary hypertension is independently associated with worse in-hospital outcomes in patients undergoing typical atrial flutter ablation, including higher mortality. Further prospective studies are required to confirm our findings.

Impact of pulmonary hypertension on lung cancer management

IntroductionThe diagnosis and management of lung cancer is challenging among patients followed-up for pulmonary hypertension (PH). Many interventional procedures are not suitable for severely ill patients, thus limiting the diagnosis and treatment of cancer. We report on patients diagnosed with both conditions in our Institution. MethodsWe conducted a retrospective observational cohort study at Toulouse University Hospital. We analysed both management and outcome for patients followed-up for precapillary PH following diagnosis of primary lung cancer. ResultsOut of 764 patients followed-up for PH, 25 went on to develop bronchopulmonary neoplasia. The median age was 69 years with a predominance of males (56%) and smokers (92%). Fifty-two percent had group 1 PH and 36% severe group 3 PH. The comorbidity burden was high and 76% were oxygen-dependent. Twenty-eight percent of patients were considered ineligible for tissue biopsy, the diagnosis being made by a multidisciplinary team (MDT) based on radio-clinical presentation. Fifty-four percent of patients did not benefit from any treatment. Sixteen percent of pulmonary diagnostic procedures were associated with complications (severe hypoxaemia, intra-alveolar hemorrhage, haemothorax). Patients were undertreated compared to disease stage guidelines (2 surgical procedures for 9 localised stages). Median survival after cancer diagnosis was 6 months. ConclusionThe management of lung cancer is complex in PH patients. The high rate of complications during the diagnosis and therapy steps coupled with very poor patient outcome for both conditions should prompt physicians to thoroughly discuss the benefit/risk benefit in each case.

Outcomes of total anomalous pulmonary venous drainage repair in neonates and the impact of pulmonary hypertension on survival

BackgroundMortality after repair of total anomalous pulmonary venous drainage (TAPVD) in neonates has remained high. Analysis of risk factors may help identify therapeutic targets to improve survival. MethodsRetrospective analysis of all neonates who underwent simple TAPVD repair. ResultsBetween 1973 and 2021, 175 neonates underwent TAPVD repair, at a median age of 6 days (interquartile range, 2-15 days) and a mean weight of 3.2 ± 0.6 kg. TAPVD was supracardiac in 42.3% of the patients (74 of 175), cardiac in 14.3% (25 of 175), infracardiac in 40% (70 of 175), and mixed type in 3.4% (6 of 175), with obstruction in 65.7% (115 of 175). Pulmonary hypertension (PHT) crisis occurred in 12% (21 of 175). Early mortality was 9.7% (17 of 175) and late mortality was 5.1% (8 of 158), with most deaths occurring within 1 year (75%; 6 of 8). Survival was 86.5% (95% CI, 80.3%-90.8%) at 1 year and 85.8% (95% CI, 79.6%-90.3%) at 5, 10, 15, and 20 years. Survival was lower in patients with obstructed TAPVD, patients with emergent surgery, and those with PHT crisis. PHT crisis (hazard ratio [HR], 4.93; 95% CI, 1.95-12.51; P = .001), urgency of surgery (HR, 2.51; 95% CI, 1.11-5.68; P = .027), and higher pulmonary artery pressure–to–systemic blood pressure percentage ratio (HR, 1.06; 95% CI, 1.01-1.11; P = .026) were identified as risk factors for mortality. Histopathological analysis of 17 patients (9.7%; 17 of 175) showed signs of pulmonary arterial hypertension with media hypertrophy in 58.8% (10 of 17). ConclusionsMortality after TAPVD repair occurred mainly within the first year of life. Urgency of surgery and persistent PHT appears to be risk factors for mortality. Lung biopsy might be useful for identifying patients at risk and guiding newer treatment modalities.

Impact of Pulmonary Hypertension on Mortality after Surgery for Aortic Stenosis.

Background and Objectives: The prognosis of patients with aortic stenosis (AS) adding pulmonary hypertension (PHT) is worse than in those with normal pulmonary artery pressure (PAP), and there are few results reported for the association between PHT and adverse outcomes of AS. We aimed to determine the predictive factors for the development of PHT in patients with surgical AS and to identify those factors that may predict the surgical prognosis. We aimed to identify the independent predictors for PHT regression at 2 years after surgery. Additionally, we tried to evaluate the involvement of PHT as an additional perioperative risk factor in patients with AS undergoing surgical aortic valve replacement (AVR). Materials and Methods: We carried out a two-year prospective study on 340 patients with AS undergoing surgical AVR. Results: The independent predictors for the occurrence of PHT in patients with surgical AS were: age > 75 years (RR = 6, p = 0.001), a restrictive left ventricle diastolic filling pattern (LVDFP) (RR = 9, p = 0.001) and associated moderate mitral regurgitation (MR) (RR = 9, p = 0.0001). The presence of severe PHT increased by 7.6 times the early postoperative risk of death, regardless of the presence of other parameters. The independent predictors for early postoperative mortality were: severe PHT, restrictive left ventricle diastolic pattern, age > 75 years, interventricular septum (IVS) thickness >18 mm and the presence of comorbidities. Conclusions: The presence of a severe PHT in patients with AS undergoing surgical AVR is associated with an early postoperative increased mortality rate. The mean PAP is a more reliable parameter for prognosis appreciation than the LV systolic function.

The Impact of Pulmonary Hypertension on the Clinical Outcomes of Acute Myocardial Infarction after Percutaneous Coronary Intervention

Background/Aims: Pulmonary hypertension (PH) in patients with heart failure contributes to a poor prognosis. However, the role of PH in the long-term clinical outcome is unclear in those with acute myocardial infarction (AMI). The clinical significance of elevated right ventricular systolic pressure (RVSP) on routine echocardiography is underestimated.Methods: This study enrolled 2,526 AMI patients (65.1 ± 12.7 years; 1,757 males [69.6%]) from the Korean AMI registry who underwent successful percutaneous coronary intervention and pre-discharge transthoracic echocardiography (TTE). The patients were divided into four groups according to the RVSP on TTE: normal RVSP (RVSP &lt; 35 mmHg, n = 1,695), mild PH (35 ≤ RVSP &lt; 45 mmHg, n = 601), moderate PH (45 ≤ RVSP &lt; 70 mmHg, n = 211), and severe PH (RVSP ≥ 70 mmHg, n = 19). Major adverse cardiac events (MACE) were compared among the four groups.Results: During the 3-year clinical follow-up period, MACE occurred in 562 patients (22.2%), including 321 (18.9%), 145 (24.1%), 83 (39.3%), and 13 patients (68.4%) in the normal RVSP and mild, moderate, and severe PH groups, respectively. On multivariate analysis, independent factors for MACE were moderate or severe PH, age ≥ 65 years, Killip class ≥ III, left ventricular ejection fraction &lt; 40%, hypertension, and diabetes.Conclusions: Measuring RVSP is useful for stratifying the risk of patients with AMI; MACE occurred in patients with moderate or severe PH.

The Impact of Pulmonary Hypertension on Functional and Morphological Parameters of Heart Function in COVID-19

The objective of the study: to evaluate functional and morphological parameters of cardiac function in patients with pulmonary hypertension and COVID-19.Subjects: The study included 53 patients of both genders with community-acquired multisegmental viral-bacterial pneumonia and COVID-19 who were treated in intensive care units. Patients were divided into three groups according to mean pulmonary artery pressure (mean PAP): in Group 1, mean PAP was &lt; 25 mm Hg, in Group 2, mean PAP was 25-40 mm Hg, and in Group 3, mean PAP was ≥ 40 mm Hg.Results. Patients with COVID-19 and mean PAP &gt; 40 mm Hg were found to have higher values of left and right atrial volume, myocardial thickness, heart rate, and mortality. However, they had lower values of arterial stroke pressure index, arterial compliance, specific peripheral resistance, and lower precapillary response.Conclusion. The severe course of COVID-19 is associated with severe pulmonary hypertension developed during extensive pneumonia combined with concomitant pathology. At the same time, impaired hemodynamics and altered sizes of heart chambers are observed in such patients.

Impact of Pulmonary Hypertension on Outcomes in Patients With Mitral Annular Calcium and Associated Mitral Valve Dysfunction

The prevalence of mitral annular calcium (MAC) is increasing in our aging population. However, data regarding prognostication in MAC-related mitral valve (MV) disease remain limited. This retrospective observational study aims to explore the prognostic impact of systolic pulmonary artery pressure (SPAP) in MAC-related MV dysfunction and define its determinants. We identified 4,384 patients (mean age 78 ± 11 years and 69% female) with MAC-related MV dysfunction (documented transmitral gradient ≥3 mm Hg) from a large institutional echocardiographic database between 2001 and 2019. In Cox regression analysis, higher SPAP strongly associated with all-cause mortality, independent of cardiovascular risk factors and indices of MV dysfunction (adjusted hazard ratio 1.22 per 10 mm Hg SPAP increase, 95% confidence interval 1.17 to 1.27). Patients with SPAP ≥50 mm Hg had significantly higher mortality compared with SPAP <50 mm Hg (log-rank p <0.001), a finding that was consistent across different transmitral gradient subgroups (≤5, 5 to 10, and ≥10 mm Hg). Independent determinants of SPAP included the mean transmitral gradient, mitral regurgitation severity, left ventricular ejection fraction, and ≥moderate aortic stenosis (adjusted p <0.05), and atrial fibrillation and left atrial dimension. The impact of concomitant mitral regurgitation on SPAP decreased at higher transmitral gradients and was no longer significant at gradients ≥10 mm Hg (p=0.100). In conclusion, SPAP strongly associates with mortality in MAC, independent of cardiovascular risk factors and indices of MAC-related MV dysfunction. These findings suggest an incremental role for SPAP in the risk stratification and prognostication in this increasingly prevalent condition with expanding the scope of possible interventions.

Impact of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation: The Experience From a Centre of Excellence

Impact of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Implantation: The Experience From a Centre of Excellence

Abstract 11984: Impact of Underlying Pulmonary Hypertension on In-Hospital Outcomes Among Patients With Septic Shock

Background: Pulmonary Hypertension (PHTN) patients typically have chronic multiple comorbidities and are more vulnerable to acute clinical conditions leading to decreased survival. The impact of pulmonary hypertension on outcomes in patients with septic shock remains unknown. Methods: Adult patients with a diagnosis of septic shock were identified in the National Readmissions Database (NRD) between the years 2016-2017. Propensity matched retrospective cross sectional clinical outcomes were compared between patients with and without non-cardiac PHTN using appropriate statistical methods after nearest matching on a 2:1 ratio for several demographic, social and clinical variables. Patients with cardiogenic shock, aortic and mitral valvular heart disease, underlying systolic and combined heart failure (HF), and PHTN due to left heart disease were excluded from the primary analysis. Appropriate ICD-10 codes were used. Results: A total of 13,676 patients diagnosed with non-cardiac PHTN and septic shock were identified with a mean age of 68 years and 58.6% identified as females. Patients with PHTN had higher comorbidities, including hypertension, chronic pulmonary disease, renal failure, diabetes, CAD, and obesity. After matching, patients with septic shock and non-cardiac PHTN were noted to have a higher mortality (33.2% vs 31.3%, p &lt; 0.001), greater vasopressor use (7.9% vs 6.6%, p &lt; 0.001), higher rates of acute heart failure (1.1% vs 0.6%, p &lt; 0.001), longer hospital stay (14.0 days vs 12.7 days, p &lt; 0.001), and higher hospital costs ($196,411 vs $171,537), when compared to patients with septic shock and without PHTN. Rates of AKI were noted to be lower in patients with PHTN. Amongst stroke outcomes, minimal differences in ischemic strokes were noted. There were no MI outcomes observed. Discussion: PHTN is associated with worse mortality, morbidity, and resource utilization outcomes in patients admitted with septic shock, except AKI. These findings should be interpreted carefully given the administrative nature of the database, and the population cohort restricted to readmissions.

Impact of pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease and its effect on healthcare utilization.

We aim to study the impact of pulmonary hypertension on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and pulmonary hypertension as a secondary diagnosis using ICD 10-CM codes. Exclusion criteria were age under 18 years, non-elective admission, and discharge in December. The primary outcome was in-hospital mortality during the index admission. Secondary outcomes were 30-day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96 h (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90%) patients had a diagnosis of pulmonary hypertension. Pulmonary hypertension was more common among females (61.14%) with a mean age of 71 ± 11.66, Medicare recipients (79.5%), higher Charlson comorbidity index, and treatment in an urban teaching hospital. Pulmonary hypertension was associated with greater mortality (adjusted odds ratio (aOR) 1.89, p < 0.001), higher 30-day readmission (aOR 1.24, p < 0.001), higher cost (adjusted mean difference (aMD) $2785, p < 0.01), length of stay (aMD 1.09, p < 0.001), and higher instrument utilization including intubation (aOR 199, p < 0.001), PIMV (aOR 2.12, p < 0.001), tracheostomy (aOR 2.1, p < 0.001), bronchoscopy (aOR 1.46, p = 0.007), and chest tube placement (aOR 1.39 p < 0.004). We found that pulmonary hypertension is related to higher in-hospital mortality, length of stay, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of pulmonary hypertension on AECOPD in hopes to improve future management.