- Email: [email protected]
RACIAL DIFFERENCES IN PATIENTS REFERRED FOR RIGHT HEART CATHETERIZATION AND RISK OF PULMONARY HYPERTENSION
1877 JACC March 21, 2017 Volume 69, Issue 11
Pulmonary Hypertension and Venous Thrombo-embolic Disease RACIAL DIFFERENCES IN PATIENTS REFERRED FOR RIGHT HEART CATHETERIZATION AND RISK OF PULMONARY HYPERTENSION Oral Contributions Room 147 B Saturday, March 18, 2017, 8:38 a.m.-8:48 a.m. Session Title: Highlighted Original Research: Pulmonary Hypertension and Venous Thrombo-embolic Disease and the Year in Review Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 904-08
Authors: Bin Yang, Tufik R. Assad, Reid D’Amico, Stephen J. Halliday, Meng Xu, Eric Farber-Eger, Quinn S. Wells, Evan L. Brittain, Vanderbilt University Medical Center, Nashville, TN, USA Background: It is unknown whether racial differences exist among pulmonary hypertension (PH) patients. We investigated the associations between race and PH in patients referred for right heart catheterization (RHC).
Methods: We extracted data for African-American (AA) and Caucasian patients undergoing RHC from 1998-2014 at Vanderbilt. PH was categorized as pulmonary arterial hypertension (PAH), isolated post-capillary PH (Ipc-PH), or combined pre- and post-capillary PH (CpcPH) according to consensus guidelines.
Results: A total of 4,583 patients were analyzed, including 587 AAs (13%) and 3,996 Caucasians (87%). Despite younger age (53±14 vs 61±15; p<0.001), AAs had a higher prevalence of cardiac disease, metabolic syndrome, and PH (73% vs 57%; p<0.001) than Caucasians (Table). In 2,693 patients with PH, pulmonary vascular disease was more severe in AAs (Table). After adjusting for age, sex, diabetes, heart failure, body mass index, hypoxic lung disease, and creatinine, AA race was independently associated with PH (OR 1.50, 95%CI 1.22-1.85; p<0.001) and Cpc-PH (OR 1.51, 95%CI 1.13-2.02; p=0.005), but not PAH (p=0.05) or Ipc-PH (p=0.64). AA race was not associated with increased adjusted mortality (p=0.92). Clinical variables for all patients referred for right heart catheterization (N=4,583) Age at right heart catheterization (years) Male sex (%) Hypertension (%) Heart failure (%) Heart failure with reduced ejection fraction (%) Heart failure with preserved ejection fraction (%) Diabetes mellitus (%) Chronic obstructive lung disease (%) Interstitial lung disease (%) Obstructive sleep apnea (%) Systemic lupus erythematous (%) Body mass index (kg/m2) Creatinine (mg/dL) Pulmonary hypertension (%) Pulmonary arterial hypertension (%) Isolated post-capillary pulmonary hypertension (%) Combined pre- and post-capillary pulmonary hypertension (%) Hemodynamic variables for patients with pulmonary hypertension (N=2,693) Right atrial pressure (mmHg) Right ventricular systolic pressure (mmHg) Mean pulmonary artery pressure (mmHg) Mean pulmonary capillary wedge pressure (mmHg) Transpulmonary pressure gradient (mmHg) Diastolic pressure gradient (mmHg) Pulmonary vascular resistance (Wood units) Pulmonary arterial oxygen saturation (%) Cardiac Index by Fick’’s Method (L/min/m2)
African-American (N=587) 53 ± 14 46 88 62 36 25 46 12 7 11 5 30.8 ± 8.3 1.8 ± 2.1 73 16
Caucasian (N=3,996) 61 ± 15 52 77 44 21 23 36 12 6 10 1 29.6 ± 7.2 1.2 ± 0.9 57 11
< 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.23 < 0.001 0.86 0.67 0.58 < 0.001 0.006 < 0.001 < 0.001 < 0.001
33
30
0.23
13
7
< 0.001
African-American (N=428) 12 ± 7 60 ± 20 40 ± 11 19 ± 9 21 ± 13 8 ± 10 4.8 ± 3.5 61 ± 11 2.6 ± 0.9
Caucasian (N=2,265) 11 ± 6 57 ± 20 38 ± 11 19 ± 8 19 ± 14 6 ± 11 4.3 ± 3.9 64 ± 10 2.7 ± 0.9
P-value
P-value 0.002 0.003 < 0.001 0.80 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Conclusion: AA patients referred for RHC had more advanced cardiac, metabolic, and pulmonary vascular disease despite being younger than Caucasians. AA race was independently associated with PH and Cpc-PH. Further studies are warranted to examine racial differences in the development of PH.
Pulmonary Hypertension and Venous Thrombo-embolic Disease RACIAL DIFFERENCES IN PATIENTS REFERRED FOR RIGHT HEART CATHETERIZATION AND RISK OF PULMONARY HYPERTENSION Oral Contributions Room 147 B Saturday, March 18, 2017, 8:38 a.m.-8:48 a.m. Session Title: Highlighted Original Research: Pulmonary Hypertension and Venous Thrombo-embolic Disease and the Year in Review Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 904-08
Authors: Bin Yang, Tufik R. Assad, Reid D’Amico, Stephen J. Halliday, Meng Xu, Eric Farber-Eger, Quinn S. Wells, Evan L. Brittain, Vanderbilt University Medical Center, Nashville, TN, USA Background: It is unknown whether racial differences exist among pulmonary hypertension (PH) patients. We investigated the associations between race and PH in patients referred for right heart catheterization (RHC).
Methods: We extracted data for African-American (AA) and Caucasian patients undergoing RHC from 1998-2014 at Vanderbilt. PH was categorized as pulmonary arterial hypertension (PAH), isolated post-capillary PH (Ipc-PH), or combined pre- and post-capillary PH (CpcPH) according to consensus guidelines.
Results: A total of 4,583 patients were analyzed, including 587 AAs (13%) and 3,996 Caucasians (87%). Despite younger age (53±14 vs 61±15; p<0.001), AAs had a higher prevalence of cardiac disease, metabolic syndrome, and PH (73% vs 57%; p<0.001) than Caucasians (Table). In 2,693 patients with PH, pulmonary vascular disease was more severe in AAs (Table). After adjusting for age, sex, diabetes, heart failure, body mass index, hypoxic lung disease, and creatinine, AA race was independently associated with PH (OR 1.50, 95%CI 1.22-1.85; p<0.001) and Cpc-PH (OR 1.51, 95%CI 1.13-2.02; p=0.005), but not PAH (p=0.05) or Ipc-PH (p=0.64). AA race was not associated with increased adjusted mortality (p=0.92). Clinical variables for all patients referred for right heart catheterization (N=4,583) Age at right heart catheterization (years) Male sex (%) Hypertension (%) Heart failure (%) Heart failure with reduced ejection fraction (%) Heart failure with preserved ejection fraction (%) Diabetes mellitus (%) Chronic obstructive lung disease (%) Interstitial lung disease (%) Obstructive sleep apnea (%) Systemic lupus erythematous (%) Body mass index (kg/m2) Creatinine (mg/dL) Pulmonary hypertension (%) Pulmonary arterial hypertension (%) Isolated post-capillary pulmonary hypertension (%) Combined pre- and post-capillary pulmonary hypertension (%) Hemodynamic variables for patients with pulmonary hypertension (N=2,693) Right atrial pressure (mmHg) Right ventricular systolic pressure (mmHg) Mean pulmonary artery pressure (mmHg) Mean pulmonary capillary wedge pressure (mmHg) Transpulmonary pressure gradient (mmHg) Diastolic pressure gradient (mmHg) Pulmonary vascular resistance (Wood units) Pulmonary arterial oxygen saturation (%) Cardiac Index by Fick’’s Method (L/min/m2)
African-American (N=587) 53 ± 14 46 88 62 36 25 46 12 7 11 5 30.8 ± 8.3 1.8 ± 2.1 73 16
Caucasian (N=3,996) 61 ± 15 52 77 44 21 23 36 12 6 10 1 29.6 ± 7.2 1.2 ± 0.9 57 11
< 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.23 < 0.001 0.86 0.67 0.58 < 0.001 0.006 < 0.001 < 0.001 < 0.001
33
30
0.23
13
7
< 0.001
African-American (N=428) 12 ± 7 60 ± 20 40 ± 11 19 ± 9 21 ± 13 8 ± 10 4.8 ± 3.5 61 ± 11 2.6 ± 0.9
Caucasian (N=2,265) 11 ± 6 57 ± 20 38 ± 11 19 ± 8 19 ± 14 6 ± 11 4.3 ± 3.9 64 ± 10 2.7 ± 0.9
P-value
P-value 0.002 0.003 < 0.001 0.80 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Conclusion: AA patients referred for RHC had more advanced cardiac, metabolic, and pulmonary vascular disease despite being younger than Caucasians. AA race was independently associated with PH and Cpc-PH. Further studies are warranted to examine racial differences in the development of PH.