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PVR estimate predicts HF hospitalization
27 March 2008
MedWire News: A novel, noninvasive estimate of pulmonary vascular resistance (PVR) predicts heart failure hospitalization independently of traditional cardiac risk factors in patients with stable coronary artery disease, claim US researchers.
They believe their findings are consistent with the hypothesis that chronic ischemic heart disease leads to adverse structural remodeling in the pulmonary vasculature of some patients.
The team estimated PVR from Doppler echocardiography measurements in 795 ambulatory patients with stable coronary disease who were taking part in the Heart and Soul study, which examined the influence of psychosocial factors on cardiovascular events.
Estimated PVR was defined as the ratio of tricuspid regurgitant velocity (TRV) to velocity-time integral (VTI) of the right ventricular outflow tract (TRV/VTIRVOT), and ranged from 5.7 to 36.0 per second (s).
After 4.3 years of follow-up, there were 161 deaths, 44 cardiovascular deaths, 103 hospitalizations for heart failure, and 120 adverse cardiovascular events.
Compared with patients in the lowest quartile (5.7-11/s) of estimated PVR, those in the highest quartile (15-36/s) were 1.8 times more likely to die, 2.9 times more likely to experience heart failure hospitalization, and twice as likely to suffer a cardiovascular event in unadjusted analyses.
On multivariate adjustment, patients in the highest quartile remained a significant 2.5 times more likely to suffer heart failure hospitalization than those in the lowest quartile.
Ramin Farzaneh-Far (University of California at San Francisco) and co-workers say that, by expressing the relationship between pulmonary artery pressure and transpulmonary blood flow, TRV/VTIRVOT retains independent prognostic value even after adjusting for pulmonary artery pressures.
"This suggests that increased PVR is a fundamental hemodynamic determinant of prognosis of patients with stable coronary artery disease," they conclude in the American Journal of Cardiology.
