04 February 2019 by Geoff Strange

Increased mortality associated with borderline pulmonary hypertension: Insights from The National Echocardiography Database of Australia

Background:

There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT), underestimate the prognostic impact of sub-clinical/borderline PHT.

Objectives:

To determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia (NEDA) cohort (N=313,492).

Methods:

We extracted echocardiographic data from NEDA. The distribution of measurable, estimated right ventricular systolic pressures (eRVSP) were examined in 157,842 men and women. All had data-linkage to long-term survival during median follow-up of 1,543, (IQR 799, 2720) days. The relationship between eRVSP and long-term mortality were then examined.

Results:

The cohort comprised 74,505 men and 83,437 women aged 65.6±17.7 years. Overall, 17,955 (11.4%), 7,016 (4.4%) and 4,515 (2.9%) individuals had eRVSP levels indicative of mild (40-49 mmHg), moderate (50-59 mmHg) or severe PHT (≥60 mmHg), respectively. As expected, these individuals were more likely to die during long-term follow up
(adjusted HR 9.73, 95% CI 8.60 – 11.0 for severe PHT; p<0.001). After adjustment for age, sex and evidence of left heart disease, a clear threshold of increased mortality equating to borderline PHT was also found: those individuals with eRVSP levels within the 3rd (28.05 to 32.0 mmHg – HR 1.410, 95% CI 1.310 to 1.517) and 4th (32.05 to 38.83 mmHg – HR 1.979, 95% 1.853 to 2.114) quintile distribution, having significantly higher mortality (p<0.001) than the lowest quintile.

Conclusions:

In the large and unique NEDA cohort, we not only confirmed the prognostic impact of clinically accepted levels of PHT, but also identified a distinctly lower threshold for increased risk of mortality (eRVSP >30mmHg) indicative of borderline PHT

About the author


profile picture of Geoff Strange

Geoff Strange

Pulmonary Hypertension Society ANZ Inc.

Australia

Key Contributors

1 Geoff Strange, PhD FCSANZ, 2 Simon Stewart, PhD FESC FAHA, 3 David S Celermajer, 4 David Prior, 5 Greg Scalia, 6 Tom Marwick, 1 Eli Gabbay, 7 Marcus Ilton, 8 Majo Joseph, 1 Jim Codde and 1 David Playford on behalf of the NEDA contributing sites Author Affiliations: 1 University of Notre Dame, Fremantle; 2 University of Cape Town; 3 Faculty of Medicine and Health, University of Sydney; 4 University of Melbourne, St Vincent’s Hospital, Melbourne; 5 University of QLD, 5 The Prince Charles Hospital, Brisbane; 6 Baker IDI Heart and Diabetes Institute, Melbourne 7 Menzies School of Health Research, Royal Darwin Hospital; 8 Flinders University, Adelaide.


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