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Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload.

Publication ,  Journal Article
Edmonston, DL; Matsouaka, R; Shah, SH; Rajagopal, S; Wolf, M
Published in: Am J Cardiol
November 15, 2021

Volume overload promotes pulmonary hypertension (PH) through pulmonary venous hypertension. However, PH with elevated pulmonary vascular resistance (hereafter PH-PVR) may develop in patients with diseases of volume overload, such as heart failure or chronic kidney disease (CKD). In such cases, volume management alone may be insufficient to slow PH progression. An accurate, noninvasive method to screen for PH-PVR in these diseases would facilitate early targeted therapy. We integrated invasive hemodynamic and echocardiography data collected from a single-center clinical cohort and identified patients with CKD or heart failure at the time of assessment. We applied penalized regression to derive a risk score of clinical parameters and echocardiography data associated with PH-PVR and categorized patients into low- (≤5 points), intermediate- (6-10 points), or high-risk (>10 points) groups. Using an internal validation strategy, we evaluated the ability of this risk score to predict PH-PVR and determined the association of this risk classification with 3-year all-cause mortality. Of 2422 patients, 42.4% had PH-PVR. In adjusted analyses, tricuspid regurgitant velocity, right ventricular function, BMI, heart rate, and hemoglobin most strongly associated with PH-PVR. The risk score significantly associated with PH-PVR (age-adjusted odds ratio 11.69 for the highest-risk group, 95% confidence interval [CI] 6.54-20.92). The high-risk group also associated with a significantly higher risk of 3-year all-cause mortality in adjusted analyses (hazard ratio 1.85, 95% CI 1.50-2.27). In conclusion, a noninvasive risk score derived from echocardiography and clinical parameters significantly associated with PH-PVR and all-cause mortality in a cohort of patients with CKD and heart failure.

Duke Scholars

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2021

Volume

159

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Vascular Resistance
  • Risk Factors
  • Middle Aged
  • Male
  • Hypertension, Pulmonary
  • Humans
  • Female
  • Cohort Studies
  • Chronic Disease
  • Cardiovascular System & Hematology
 

Citation

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Edmonston, D. L., Matsouaka, R., Shah, S. H., Rajagopal, S., & Wolf, M. (2021). Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload. Am J Cardiol, 159, 113–120. https://doi.org/10.1016/j.amjcard.2021.08.016
Edmonston, Daniel L., Roland Matsouaka, Svati H. Shah, Sudarshan Rajagopal, and Myles Wolf. “Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload.Am J Cardiol 159 (November 15, 2021): 113–20. https://doi.org/10.1016/j.amjcard.2021.08.016.
Edmonston DL, Matsouaka R, Shah SH, Rajagopal S, Wolf M. Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload. Am J Cardiol. 2021 Nov 15;159:113–20.
Edmonston, Daniel L., et al. “Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload.Am J Cardiol, vol. 159, Nov. 2021, pp. 113–20. Pubmed, doi:10.1016/j.amjcard.2021.08.016.
Edmonston DL, Matsouaka R, Shah SH, Rajagopal S, Wolf M. Noninvasive Risk Score to Screen for Pulmonary Hypertension With Elevated Pulmonary Vascular Resistance in Diseases of Chronic Volume Overload. Am J Cardiol. 2021 Nov 15;159:113–120.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

November 15, 2021

Volume

159

Start / End Page

113 / 120

Location

United States

Related Subject Headings

  • Vascular Resistance
  • Risk Factors
  • Middle Aged
  • Male
  • Hypertension, Pulmonary
  • Humans
  • Female
  • Cohort Studies
  • Chronic Disease
  • Cardiovascular System & Hematology