The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease

Emmanouil Tampakakis, Peter J. Leary, Van N. Selby, Teresa De Marco, Thomas P. Cappola, G. Michael Felker, Stuart D. Russell, Edward K Kasper, Ryan J. Tedford

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to evaluate if diastolic pulmonary gradient (DPG) can predict survival in patients with pulmonary hypertension due to left heart disease (PH-LHD). Background: Patients with combined post- and pre-capillary PH-LHD have worse prognosis than those with passive pulmonary hypertension. The transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) have commonly been used to identify high-risk patients. However, these parameters have significant shortcomings and do not always correlate with pulmonary vasculature remodeling. Recently, it has been suggested that DPG may be better a marker, yetits prognostic ability in patients with cardiomyopathy has not been fully assessed. Methods: A retrospective cohort of 1,236 patients evaluated for unexplained cardiomyopathy at Johns Hopkins Hospital was studied. All patients underwent right heart catheterization and were followed until death, cardiac transplantation, or the end of the study period (mean time 4.4 years). The relationships between DPG, TPG, or PVR and survival in subjects with PH-LHD (n= 469) were evaluated with Cox proportional hazards regression and Kaplan-Meier analyses. Results: DPG was not significantly associated with mortality (hazard ratio [HR]: 1.02, p= 0.10) in PH-LHD whereas elevated TPG and PVR predicted death (HR: 1.02, p= 0.046; and HR: 1.11, p= 0.002, respectively). Similarly, DPG didnot differentiate survivors from non-survivors at any selected cut points including a DPG of 7 mmHg. Conclusions: In this retrospective study of patients with cardiomyopathy and PH-LHD, an elevated DPG was not associated with worse survival.

Original languageEnglish (US)
Pages (from-to)9-16
Number of pages8
JournalJACC: Heart Failure
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2015

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Pulmonary Hypertension
Heart Diseases
Lung
Survival
Cardiomyopathies
Vascular Resistance
Kaplan-Meier Estimate
Patient Rights
Heart Transplantation
Cardiac Catheterization
Survivors
Retrospective Studies
Mortality

Keywords

  • Diastolic pulmonary gradient
  • Left heart disease
  • Pulmonary hypertension
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. / Tampakakis, Emmanouil; Leary, Peter J.; Selby, Van N.; De Marco, Teresa; Cappola, Thomas P.; Felker, G. Michael; Russell, Stuart D.; Kasper, Edward K; Tedford, Ryan J.

In: JACC: Heart Failure, Vol. 3, No. 1, 01.01.2015, p. 9-16.

Research output: Contribution to journalArticle

Tampakakis, Emmanouil ; Leary, Peter J. ; Selby, Van N. ; De Marco, Teresa ; Cappola, Thomas P. ; Felker, G. Michael ; Russell, Stuart D. ; Kasper, Edward K ; Tedford, Ryan J. / The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. In: JACC: Heart Failure. 2015 ; Vol. 3, No. 1. pp. 9-16.
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abstract = "Objectives: This study sought to evaluate if diastolic pulmonary gradient (DPG) can predict survival in patients with pulmonary hypertension due to left heart disease (PH-LHD). Background: Patients with combined post- and pre-capillary PH-LHD have worse prognosis than those with passive pulmonary hypertension. The transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) have commonly been used to identify high-risk patients. However, these parameters have significant shortcomings and do not always correlate with pulmonary vasculature remodeling. Recently, it has been suggested that DPG may be better a marker, yetits prognostic ability in patients with cardiomyopathy has not been fully assessed. Methods: A retrospective cohort of 1,236 patients evaluated for unexplained cardiomyopathy at Johns Hopkins Hospital was studied. All patients underwent right heart catheterization and were followed until death, cardiac transplantation, or the end of the study period (mean time 4.4 years). The relationships between DPG, TPG, or PVR and survival in subjects with PH-LHD (n= 469) were evaluated with Cox proportional hazards regression and Kaplan-Meier analyses. Results: DPG was not significantly associated with mortality (hazard ratio [HR]: 1.02, p= 0.10) in PH-LHD whereas elevated TPG and PVR predicted death (HR: 1.02, p= 0.046; and HR: 1.11, p= 0.002, respectively). Similarly, DPG didnot differentiate survivors from non-survivors at any selected cut points including a DPG of 7 mmHg. Conclusions: In this retrospective study of patients with cardiomyopathy and PH-LHD, an elevated DPG was not associated with worse survival.",
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AU - Selby, Van N.

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AU - Cappola, Thomas P.

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AU - Russell, Stuart D.

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AU - Tedford, Ryan J.

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AB - Objectives: This study sought to evaluate if diastolic pulmonary gradient (DPG) can predict survival in patients with pulmonary hypertension due to left heart disease (PH-LHD). Background: Patients with combined post- and pre-capillary PH-LHD have worse prognosis than those with passive pulmonary hypertension. The transpulmonary gradient (TPG) and pulmonary vascular resistance (PVR) have commonly been used to identify high-risk patients. However, these parameters have significant shortcomings and do not always correlate with pulmonary vasculature remodeling. Recently, it has been suggested that DPG may be better a marker, yetits prognostic ability in patients with cardiomyopathy has not been fully assessed. Methods: A retrospective cohort of 1,236 patients evaluated for unexplained cardiomyopathy at Johns Hopkins Hospital was studied. All patients underwent right heart catheterization and were followed until death, cardiac transplantation, or the end of the study period (mean time 4.4 years). The relationships between DPG, TPG, or PVR and survival in subjects with PH-LHD (n= 469) were evaluated with Cox proportional hazards regression and Kaplan-Meier analyses. Results: DPG was not significantly associated with mortality (hazard ratio [HR]: 1.02, p= 0.10) in PH-LHD whereas elevated TPG and PVR predicted death (HR: 1.02, p= 0.046; and HR: 1.11, p= 0.002, respectively). Similarly, DPG didnot differentiate survivors from non-survivors at any selected cut points including a DPG of 7 mmHg. Conclusions: In this retrospective study of patients with cardiomyopathy and PH-LHD, an elevated DPG was not associated with worse survival.

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