Abstract | OBJECTIVES: The purpose of this study was to determine among community patients with heart failure (HF) whether pulmonary artery systolic pressure ( PASP) assessed by Doppler echocardiography was associated with death and improved risk prediction over established factors, using the integrated discrimination improvement and net reclassification improvement. BACKGROUND: METHODS: Between 2003 and 2010, Olmsted County residents with HF prospectively underwent assessment of ejection fraction, diastolic function, and PASP by Doppler echocardiography. RESULTS:
PASP was recorded in 1,049 of 1,153 patients (mean age 76 ± 13; 51% women). Median PASP was 48 mm Hg (25th to 75th percentile: 37.0 to 58.0). There were 489 deaths after a follow-up of 2.7 ± 1.9 years. There was a strong positive graded association between PASP and mortality. Increasing PASP was associated with an increased risk of death (hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 1.13 to 1.85 for tertile 2; HR: 2.07, 95% CI: 1.62 to 2.64 for tertile 3 vs. tertile 1), independently of age, sex, comorbidities, ejection fraction, and diastolic function. Adding PASP to models including these clinical characteristics resulted in an increase in the c-statistic from 0.704 to 0.742 (p = 0.007), an integrated discrimination improvement gain of 4.2% (p < 0.001), and a net reclassification improvement of 14.1% (p = 0.002), indicating that PASP improved prediction of death over traditional prognostic factors. All results were similar for cardiovascular death. CONCLUSIONS: Among community patients with HF, PASP strongly predicts death and provides incremental and clinically relevant prognostic information independently of known predictors of outcomes.
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Authors | Francesca Bursi, Sheila M McNallan, Margaret M Redfield, Vuyisile T Nkomo, Carolyn S P Lam, Susan A Weston, Ruoxiang Jiang, Véronique L Roger |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 59
Issue 3
Pg. 222-31
(Jan 17 2012)
ISSN: 1558-3597 [Electronic] United States |
PMID | 22240126
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Cohort Studies
- Female
- Follow-Up Studies
- Heart Failure
(mortality, physiopathology)
- Humans
- Hypertension, Pulmonary
(mortality, physiopathology)
- Male
- Middle Aged
- Population Surveillance
(methods)
- Prospective Studies
- Pulmonary Wedge Pressure
(physiology)
- Residence Characteristics
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