PMID- 17045937
OWN - NLM
STAT- MEDLINE
DCOM- 20070418
LR  - 20211223
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 25
IP  - 10
DP  - 2006 Oct
TI  - Prognostic implications of serial assessments of pulmonary hypertension in severe 
      chronic heart failure.
PG  - 1241-6
AB  - BACKGROUND: It is unknown whether time-related changes of pulmonary hypertension 
      (PH) have prognostic relevance in severe chronic heart failure (CHF). METHODS: 
      All CHF patients referred for follow-up from 1996 through 2003 were screened for 
      this study. Eligibility depended on availability of a concomitant clinical, 
      laboratory, electrocardiographic (ECG), echocardiographic and right-heart 
      catheterization (RHC) assessment at index evaluation, as well as absence of 
      pre-capillary PH. RESULTS: One hundred ninety-six patients (age 54 +/- 9 years; 
      27% women, 73% men; 50% in New York Heart Association [NYHA] Class III or IV) 
      were included. PH at index evaluation was an independent predictor of acute heart 
      failure or cardiovascular death (AHF/CD), with adjusted risk ratio (RR) = 2.30, 
      95% confidence interval (CI) 1.42 to 3.73 and p < 0.001. A pre-study (> or =6 
      months) RHC was available for 174 of the 196 patients. Worsening of mean 
      pulmonary artery pressure (mPAP) of > or =30% (a pre-specified cut-off 
      corresponding to the 75th percentile of DeltamPAP%) provided prognostic 
      information independent of all index-evaluation parameters (adjusted RR = 2.60, 
      95% CI 1.45 to 4.67, p = 0.001), and from time-related changes in the other 
      hemodynamic parameters (p < or = 0.033). CONCLUSIONS: PH retains independent 
      prognostic significance even after adjusting for a large set of 
      clinical/laboratory/instrumental parameters. Furthermore, serial measurements of 
      mPAP seem to provide additional prognostic information as compared with a single 
      assessment. These findings indicate that serial evaluations of PAP may help 
      identify a sub-set of high-risk CHF patients deserving a particularly close 
      follow-up to facilitate timely indications for non-pharmacologic strategies, 
      including (when appropriate) heart transplantation.
FAU - Grigioni, Francesco
AU  - Grigioni F
AD  - Cardiology Institute, University of Bologna, Bologna, Italy. 
      francesco.grigioni@unibo.it
FAU - Potena, Luciano
AU  - Potena L
FAU - Galie, Nazzareno
AU  - Galie N
FAU - Fallani, Francesco
AU  - Fallani F
FAU - Bigliardi, Mauro
AU  - Bigliardi M
FAU - Coccolo, Fabio
AU  - Coccolo F
FAU - Magnani, Gaia
AU  - Magnani G
FAU - Manes, Alessandra
AU  - Manes A
FAU - Barbieri, Andrea
AU  - Barbieri A
FAU - Fucili, Alessandro
AU  - Fucili A
FAU - Magelli, Carlo
AU  - Magelli C
FAU - Branzi, Angelo
AU  - Branzi A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20060907
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
SB  - IM
MH  - Acute Disease
MH  - *Blood Pressure
MH  - Blood Pressure Determination/*methods
MH  - Cardiac Output, Low/*physiopathology
MH  - Cardiovascular Diseases/mortality
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Hypertension, Pulmonary/diagnosis/*physiopathology
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Pulmonary Artery/*physiopathology
MH  - Severity of Illness Index
EDAT- 2006/10/19 09:00
MHDA- 2007/04/19 09:00
CRDT- 2006/10/19 09:00
PHST- 2006/04/25 00:00 [received]
PHST- 2006/06/15 00:00 [revised]
PHST- 2006/06/27 00:00 [accepted]
PHST- 2006/10/19 09:00 [pubmed]
PHST- 2007/04/19 09:00 [medline]
PHST- 2006/10/19 09:00 [entrez]
AID - S1053-2498(06)00494-3 [pii]
AID - 10.1016/j.healun.2006.06.015 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2006 Oct;25(10):1241-6. doi: 
      10.1016/j.healun.2006.06.015. Epub 2006 Sep 7.