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The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease.

Publication ,  Journal Article
Tampakakis, E; Leary, PJ; Selby, VN; De Marco, T; Cappola, TP; Felker, GM; Russell, SD; Kasper, EK; Tedford, RJ
Published in: JACC Heart Fail
January 2015

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.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

January 2015

Volume

3

Issue

1

Start / End Page

9 / 16

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Vascular Resistance
  • United States
  • Survival Rate
  • Retrospective Studies
  • Pulmonary Wedge Pressure
  • Prognosis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
 

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Tampakakis, E., Leary, P. J., Selby, V. N., De Marco, T., Cappola, T. P., Felker, G. M., … Tedford, R. J. (2015). The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail, 3(1), 9–16. https://doi.org/10.1016/j.jchf.2014.07.010
Tampakakis, Emmanouil, Peter J. Leary, Van N. Selby, Teresa De Marco, Thomas P. Cappola, G Michael Felker, Stuart D. Russell, Edward K. Kasper, and Ryan J. Tedford. “The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease.JACC Heart Fail 3, no. 1 (January 2015): 9–16. https://doi.org/10.1016/j.jchf.2014.07.010.
Tampakakis E, Leary PJ, Selby VN, De Marco T, Cappola TP, Felker GM, et al. The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail. 2015 Jan;3(1):9–16.
Tampakakis, Emmanouil, et al. “The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease.JACC Heart Fail, vol. 3, no. 1, Jan. 2015, pp. 9–16. Pubmed, doi:10.1016/j.jchf.2014.07.010.
Tampakakis E, Leary PJ, Selby VN, De Marco T, Cappola TP, Felker GM, Russell SD, Kasper EK, Tedford RJ. The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail. 2015 Jan;3(1):9–16.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

January 2015

Volume

3

Issue

1

Start / End Page

9 / 16

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Vascular Resistance
  • United States
  • Survival Rate
  • Retrospective Studies
  • Pulmonary Wedge Pressure
  • Prognosis
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate