PMID- 33962868
OWN - NLM
STAT- MEDLINE
DCOM- 20220131
LR  - 20220716
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Print)
IS  - 1053-2498 (Linking)
VI  - 40
IP  - 7
DP  - 2021 Jul
TI  - Is pulmonary vascular resistance index better than pulmonary vascular resistance 
      in predicting outcomes in pulmonary arterial hypertension?
PG  - 614-622
LID - S1053-2498(21)02263-4 [pii]
LID - 10.1016/j.healun.2021.03.022 [doi]
AB  - BACKGROUND: In contrast to pulmonary vascular resistance (PVR), PVR index (PVRI) 
      accounts for variations in body habitus. We tested the association of PVRI 
      compared to PVR with clinical outcomes in lean and obese (BMI >/=30 kg/m(2)) 
      patients with pulmonary arterial hypertension (PAH). METHODS: This retrospective 
      study included adult patients with PAH who underwent right heart catheterization 
      at Cleveland Clinic between February 1992 and November 2019. RESULTS: We included 
      644 patients (mean age, 53 +/- 16 years, and 74 % females). PAH was idiopathic or 
      heritable in 44% of patients. Cardiac output increased (p <0.0001), while PVR 
      decreased (p <0.0001) with increasing body weight. Both PVR and PVRI were 
      associated with markers of disease severity, with more pronounced association for 
      PVRI. Both PVR and PVRI were risk factors for first PAH hospitalization, 
      mortality and mortality or lung transplant in the whole cohort and the group of 
      patients with BMI < 30 kg/m(2). However, PVRI (HR (95% CI): 1.06 (1.02 -1.11)), 
      but not PVR (HR (95% CI): 1.03 (0.99-1.07)), was a risk factor for first PAH 
      hospitalization in obese patients. In the obese group, neither PVR nor PVRI were 
      risk factors for mortality. CONCLUSIONS: PVRI appears to have a stronger 
      association than PVR with disease severity markers in PAH; however, both PVR and 
      PVRI were similarly associated with hospitalizations and survival in the overall 
      cohort. We found no strong evidence to recommend a change from PVR to PVRI in the 
      definition of PAH.
CI  - Copyright (c) 2021 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Khirfan, Ghaleb
AU  - Khirfan G
AD  - Department of Pulmonary and Critical Care Medicine, Respiratory Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Li, Manshi
AU  - Li M
AD  - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
FAU - Wang, Xiaofeng
AU  - Wang X
AD  - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
FAU - Dweik, Raed A
AU  - Dweik RA
AD  - Department of Pulmonary, Allergy and Critical Care Medicine. Respiratory 
      Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Heresi, Gustavo A
AU  - Heresi GA
AD  - Department of Pulmonary and Critical Care Medicine. Respiratory Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Tonelli, Adriano R
AU  - Tonelli AR
AD  - Staff, Department of Pulmonary and Critical Care Medicine. Respiratory Institute, 
      Cleveland Clinic, Cleveland, Ohio. Electronic address: tonella@ccf.org.
LA  - eng
GR  - R01 HL130307/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210402
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  - Cardiac Catheterization
MH  - Cardiac Output/*physiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ohio/epidemiology
MH  - Prognosis
MH  - Pulmonary Arterial Hypertension/diagnosis/mortality/*physiopathology
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Vascular Resistance/*physiology
PMC - PMC8238810
MID - NIHMS1690813
OTO - NOTNLM
OT  - mortality
OT  - outcome
OT  - pulmonary arterial hypertension
OT  - pulmonary vascular resistance
OT  - pulmonary vascular resistance index
COIS- Conflict of interest The authors have no significant conflicts of interest with 
      any companies or organization whose products or services may be discussed in this 
      article except for Gustavo A. Heresi, who received personal fees for being a 
      member in Bayer Healthcare - Advisory Board and Speaking.
EDAT- 2021/05/09 06:00
MHDA- 2022/02/01 06:00
PMCR- 2022/07/01
CRDT- 2021/05/08 06:19
PHST- 2020/11/24 00:00 [received]
PHST- 2021/03/09 00:00 [revised]
PHST- 2021/03/29 00:00 [accepted]
PHST- 2021/05/09 06:00 [pubmed]
PHST- 2022/02/01 06:00 [medline]
PHST- 2021/05/08 06:19 [entrez]
PHST- 2022/07/01 00:00 [pmc-release]
AID - S1053-2498(21)02263-4 [pii]
AID - 10.1016/j.healun.2021.03.022 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2021 Jul;40(7):614-622. doi: 
      10.1016/j.healun.2021.03.022. Epub 2021 Apr 2.