PVR BUT NOT DPG PREDICTS CARDIAC HOSPITALIZATIONS IN LEFT HEART DISEASE-ASSOCIATED PULMONARY HYPERTENSION

2075 JACC April 5, 2016 Volume 67, Issue 13

Pulmonary Hypertension and Venous Thrombo-embolic Disease PVR BUT NOT DPG PREDICTS CARDIAC HOSPITALIZATIONS IN LEFT HEART DISEASE-ASSOCIATED PULMONARY HYPERTENSION Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: Novel Prognostic Markers in Pulmonary Vascular Disease Abstract Category: 36. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1265-310 Authors: Rebecca R. Vanderpool, Melissa Saul, Seyed-Mehdi Nouraie, Mark Gladwin, Marc Simon, Pittsburgh Heart, Lung, Blood, Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA, Howard University, Washington DC, DC, USA Background: Both PVR and DPG are used to identify pre-capillary involvement in pulmonary hypertension in the setting of Left Heart Disease (PH-LHD). Significant hospitalization rates exist in heart failure and we hypothesized increased cardiac hospitalization in PH-LHD with pre-capillary involvement.

Methods: Study includes 11,023 subjects who had a right heart catheterization (RHC) between 2005 and 2012 at UPMC Presbyterian Hospital. Pre-capillary involvement in PH-LHD (mPAP ≥25 mmHg and PCWP ≥15 mmHg) was quantified by TPG, PVR and DPG. Cardiac hospitalizations were identified as inpatient, emergency, or outpatient under direct observation visits with a primary International Classification of Diseases, 9th Revision (ICD 9) diagnosis code for hypertension (401-405), coronary artery disease (410-414), dysrhythmia (427), heart failure (428) or cerebrovascular disease (430-438). Hospitalization predictors were determined using Cox regression, ROC curves and Kaplan-Meier analysis. Results: A third of PH-LHD (1539/4621) had a cardiac hospitalization within 436 ± 375 days their RHC. Significant predictors include age, RAP, mPAP, PCWP, CI, compliance and PVR (Table 1) but only age, mPAP, CI, PVR are predictive in a multivariate analysis. Significantly more hospitalizations occurred in subjects with a high mPAP, low cardiac index or high PVR.

Conclusions: Subjects with pre-capillary involvement in PH-LHD quantified by PVR ≥ 1.8 but not DPG had significantly increased cardiac hospitalizations. Cox regression and ROC analysis used to determine factors prognostic of cardiac hospitalizations. Multivariate Univariate Hazard Ratio Parameter Hazard Ratio P-value P-value [lower 95% [lower 95% - upper 95%] upper 95%] 1.0 1.0 Age 0.0004 0.0009 [1.0-1.0] [1.0-1.0] 1.0 RA pressure <0.0001 [1.0-1.0] mean PA pressure Pulmonary capillary wedge pressure Cardiac Index PA compliance Transpulmonary Gradient (TPG) (mPAP - PCWP) Pulmonary vascular resistance (PVR) Diastolic Pulmonary Gradient (DPG) (dPAP-PCWP)

1.0 [1.0-1.0] 1.0 [1.0-1.0] 0.8 [0.7-0.8] 0.9 [0.8-0.9] 1.0 [1.0-1.0] 1.0 [1.0-1.0] 1.0 [1.0-1.0]

<0.0001

ROC AUC

Cut-off (Sensitivity, Specificity)

49.8%

53 years (81%, 22%)

1.0 [1.0-1.0]

0.002

52.8%

32 mmHg (75%, 30%)

0.7 [0.7-0.8]

<0.0001

55.7%

2.2 L/min/m^2 (39%, 70%)

1.0 [1.0-1.0]

<0.0001

53.8%

1.8 mmHg/L/min (73%, 33%)

0.001 <0.0001 <0.0001 0.7 0.03 0.4