A high probability of pulmonary hypertension (PH) as assessed with echocardiography was found to be a better predictor of mortality and readmission than left ventricular ejection fraction (LVEF) and right ventricular function (RVF) in patients with acute decompensated heart failure, according to a study published in the Journal of Clinical Medicine.
In this study, the probability of developing PH was evaluated in 657 patients (median age, 78.7 years) admitted with acute decompensated heart failure recruited between November 2014 and September 2018. Patient information such as age, weight, tobacco use, and full medical history were included in the analyses. Outcomes including mortality, readmission, clinical state, and medication were assessed at 3, 12, and 24 months and every year thereafter. Left and right cardiac chamber characteristics measured with echocardiography were recorded.
A total of 117 and 540 patients were found to have a high and low or intermediate probability of PH, respectively. Reduced RVF was associated with a high probability of PH, with no significant difference for LVEF. In the unadjusted analysis, LVEF was not associated with mortality or readmission, but high probability of PH (hazard ratio [HR], 1.67; 95% CI, 1.33-2.09; P <.001), chronic kidney disease (HR, 1.49; 95% CI, 1.23-1.80, P <.001), and chronic anemia (HR, 1.45; 95% CI, 1.20-1.75; P <.001) were associated with higher mortality and readmission rates. The multivariate analysis of all-cause mortality or readmission took into account the high probability of PH, reduced LVEF, reduced RVF, aortic stenosis, mitral stenosis, and history of chronic obstructive pulmonary disease. High probability of PH was found to be associated with a poor outcome (HR, 1.67; 95% CI, 1.29-2.17; P <.001). Aortic stenosis (HR, 1.5; 95% CI, 1.06-2.12; P =.02), mitral stenosis (HR, 2.37; 95% CI, 1.2-4.66; P =.01), and a history of chronic obstructive pulmonary disease (HR, 1.47; 95% CI, 1.13-1.91; P =.004), but not reduced LVEF or RVF, were found to be associated with poor outcomes.
Study limitations include its observational nature, and the fact that the data on past medical history were obtained from medical records.
“In patients admitted for [acute decompensated heart failure], a high probability of PH as evaluated by echocardiography, was the strongest predictor of all-cause mortality and hospital readmission. LVEF and RVF were not independently associated with prognosis,” noted the study authors. “This suggests that the non-invasive estimation of PH in this setting provides important prognostic information, and its use in routine patient management could lead to improved clinical outcomes.”
Carballo S, Musso P, Garin N, et al. Prognostic value of the echocardiographic probability of pulmonary hypertension in patients with acute decompensated heart failure [published online October 15, 2019]. J Clin Med. doi:10.3390/jcm8101684