Elsevier

JACC: Heart Failure

Volume 3, Issue 1, January 2015, Pages 9-16
JACC: Heart Failure

Mini-Focus Issue: Pulmonary Hypertension
The Diastolic Pulmonary Gradient Does Not Predict Survival in Patients With Pulmonary Hypertension Due to Left Heart Disease

https://doi.org/10.1016/j.jchf.2014.07.010Get rights and content
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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, yet its 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 did not differentiate survivors from non-survivors at any selected cut points including a DPG of 7 mm Hg.

Conclusions

In this retrospective study of patients with cardiomyopathy and PH-LHD, an elevated DPG was not associated with worse survival.

Key Words

diastolic pulmonary gradient
pulmonary hypertension
left heart disease
survival

Abbreviations and Acronyms

CpcPH
combined post-capillary and pre-capillary pulmonary hypertension
dPAP
diastolic pulmonary artery pressure
DPG
diastolic pulmonary gradient
HR
hazard ratio
mPAP
mean pulmonary artery pressure
PCWP
pulmonary capillary wedge pressure
PH
pulmonary hypertension
PH-LHD
pulmonary hypertension due to left heart disease
PVR
pulmonary vascular resistance
TPG
transpulmonary gradient

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All authors have reported that they have no relationships relevant to the contents of this paper to disclose.