Risk Prediction in Pulmonary Hypertension Due to Chronic Heart Failure: Incremental Prognostic Value of Pulmonary Hemodynamics

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2022 Feb 17

PMID 35172722

Authors

Ruilin Quan

Shian Huang

Lingpin Pang

Jieyan Shen

Weifeng Wu

Fangming Tang

Xiulong Zhu

Weiqing Su

Jingzhi Sun

Zaixin Yu

Lemin Wang

Xianyang Zhu

Changming Xiong

Jianguo He

Affiliations

Soon will be listed here.

Abstract

Background: There is no generally accepted comprehensive risk prediction model cooperating risk factors associated with heart failure and pulmonary hemodynamics for patients with pulmonary hypertension due to left heart disease (PH-LHD). We aimed to explore outcome correlates and evaluate incremental prognostic value of pulmonary hemodynamics for risk prediction in PH-LHD.

Methods: Consecutive patients with chronic heart failure undergoing right heart catheterization were prospectively enrolled. The primary endpoint was all-cause mortality. Individual variable selection was performed by machine learning methods. Cox proportional hazards models were conducted to identify the association between variables and mortality. Incremental value of hemodynamics was evaluated based on the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores.

Results: A total of 276 PH-LHD patients were enrolled, with a median follow-up time of 34.7 months. By L1-penalized regression model and random forest approach, diastolic pressure gradient (DPG) and mixed venous oxygen saturation (SvO) were the hemodynamic predictors most strongly associated with mortality (coefficient: 0.0255 and -0.0176, respectively), with consistent significance after adjusted for SHFM [DPG: HR 1.067, 95% CI 1.024-1.113, P = 0.022; SvO: HR 0.969, 95% CI 0.953-0.985, P = 0.002] or MAGGIC (DPG: HR 1.069, 95% CI 1.026-1.114, P = 0.011; SvO: HR 0.970, 95% CI 0.954-0.986, P = 0.004) scores. The inclusion of DPG and SvO improved risk prediction compared with using SHFM [net classification improvement (NRI): 0.468 (0.161-0.752); integrated discriminatory index (IDI): 0.092 (0.035-0.171); likelihood ratio test: P < 0.001] or MAGGIC [NRI: 0.298 (0.106-0.615); IDI: 0.084 (0.033-0.151); likelihood ratio: P < 0.001] scores alone.

Conclusion: In PH-LHD, pulmonary hemodynamics can provide incremental prognostic value for risk prediction.

Clinical Trial Registration: NCT02164526 at https://clinicaltrials.gov .

Citing Articles

Deep Convolutional Generative Adversarial Network for Improved Cardiac Image Classification in Heart Disease Diagnosis.

S G, B L J Imaging Inform Med. 2024; .

PMID: 39653875 DOI: 10.1007/s10278-024-01343-z.

References

Pocock S, Ariti C, McMurray J, Maggioni A, Kober L, Squire I . Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2012; 34(19):1404-13. DOI: 10.1093/eurheartj/ehs337. View

Bloos F, Reinhart K . Venous oximetry. Intensive Care Med. 2005; 31(7):911-3. DOI: 10.1007/s00134-005-2670-9. View

Onoue T, Iwataki M, Araki M, Akashi J, Kitano T, Nabeshima Y . Novel noninvasive estimation of mixed venous oxygen saturation by echocardiography and expired gas analysis. Am J Physiol Heart Circ Physiol. 2020; 319(5):H1078-H1086. PMC: 8083080. DOI: 10.1152/ajpheart.00429.2020. View

Kylhammar D, Kjellstrom B, Hjalmarsson C, Jansson K, Nisell M, Soderberg S . A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur Heart J. 2017; 39(47):4175-4181. DOI: 10.1093/eurheartj/ehx257. View

Ibe T, Wada H, Sakakura K, Ikeda N, Yamada Y, Sugawara Y . Pulmonary hypertension due to left heart disease: The prognostic implications of diastolic pulmonary vascular pressure gradient. J Cardiol. 2015; 67(6):555-9. DOI: 10.1016/j.jjcc.2015.07.015. View

Vanderpool R, Saul M, Nouraie M, Gladwin M, Simon M . Association Between Hemodynamic Markers of Pulmonary Hypertension and Outcomes in Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. 2018; 3(4):298-306. PMC: 5875307. DOI: 10.1001/jamacardio.2018.0128. View

Hoeper M, Kramer T, Pan Z, Eichstaedt C, Spiesshoefer J, Benjamin N . Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. Eur Respir J. 2017; 50(2). DOI: 10.1183/13993003.00740-2017. View

Vachiery J, Tedford R, Rosenkranz S, Palazzini M, Lang I, Guazzi M . Pulmonary hypertension due to left heart disease. Eur Respir J. 2018; 53(1). PMC: 6351334. DOI: 10.1183/13993003.01897-2018. View

Benza R, Gomberg-Maitland M, Miller D, Frost A, Frantz R, Foreman A . The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension. Chest. 2011; 141(2):354-362. DOI: 10.1378/chest.11-0676. View

10.

Agarwal R, Shah S, Foreman A, Glassner C, Bartolome S, Safdar Z . Risk assessment in pulmonary hypertension associated with heart failure and preserved ejection fraction. J Heart Lung Transplant. 2012; 31(5):467-77. DOI: 10.1016/j.healun.2011.11.017. View

11.

Levy W, Mozaffarian D, Linker D, Sutradhar S, Anker S, Cropp A . The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006; 113(11):1424-33. DOI: 10.1161/CIRCULATIONAHA.105.584102. View

12.

Gerges M, Gerges C, Pistritto A, Lang M, Trip P, Jakowitsch J . Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival. Am J Respir Crit Care Med. 2015; 192(10):1234-46. DOI: 10.1164/rccm.201503-0529OC. View

13.

Naeije R, Gerges M, Vachiery J, Caravita S, Gerges C, Lang I . Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure. Circ Heart Fail. 2017; 10(9). DOI: 10.1161/CIRCHEARTFAILURE.117.004082. View

14.

Boucly A, Weatherald J, Savale L, Jais X, Cottin V, Prevot G . Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension. Eur Respir J. 2017; 50(2). DOI: 10.1183/13993003.00889-2017. View

15.

Galie N, Humbert M, Vachiery J, Gibbs S, Lang I, Torbicki A . 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS):.... Eur Heart J. 2015; 37(1):67-119. DOI: 10.1093/eurheartj/ehv317. View

16.

Miller W, Grill D, Borlaug B . Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: pulmonary hypertension and heart failure. JACC Heart Fail. 2014; 1(4):290-299. DOI: 10.1016/j.jchf.2013.05.001. View

17.

McMurray J, Adamopoulos S, Anker S, Auricchio A, Bohm M, Dickstein K . ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the.... Eur J Heart Fail. 2012; 14(8):803-69. DOI: 10.1093/eurjhf/hfs105. View

18.

Bilchick K, Wang Y, Cheng A, Curtis J, Dharmarajan K, Stukenborg G . Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators. J Am Coll Cardiol. 2017; 69(21):2606-2618. PMC: 5502749. DOI: 10.1016/j.jacc.2017.03.568. View

19.

Palazzini M, Dardi F, Manes A, Bacchi Reggiani M, Gotti E, Rinaldi A . Pulmonary hypertension due to left heart disease: analysis of survival according to the haemodynamic classification of the 2015 ESC/ERS guidelines and insights for future changes. Eur J Heart Fail. 2017; 20(2):248-255. DOI: 10.1002/ejhf.860. View

20.

Benza R, Miller D, Gomberg-Maitland M, Frantz R, Foreman A, Coffey C . Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010; 122(2):164-72. DOI: 10.1161/CIRCULATIONAHA.109.898122. View