CLINICAL RESEARCH: SYSTEMIC AND PULMONARY HYPERTENSION
Relationship of Pulmonary Arterial Capacitance and Mortality in Idiopathic Pulmonary Arterial Hypertension
Srijoy Mahapatra, MD*,
Rick A. Nishimura, MD*,*,
Paul Sorajja, MD*,
Stephen Cha, MS and
Michael D. McGoon, MD*
* Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
Division of Biostatistics, Mayo Clinic, Rochester, Minnesota.
Manuscript received June 20, 2005;
revised manuscript received September 5, 2005,
accepted September 13, 2005.
* Reprint requests and correspondence: Dr. Rick A Nishimura, 200 First Street, SW, Rochester, Minnesota 55902. (Email: rnishimura{at}mayo.edu).
OBJECTIVES: The purpose of this study was to determine if pulmonary vascular capacitance predicts survival in patients with idiopathic pulmonary arterial hypertension (IPAH).
BACKGROUND: The prognosis of patients with IPAH is difficult to predict, despite knowledge of clinical and hemodynamic parameters previously identified as predictors.
METHODS: We proposed a capacitance index of stroke volume divided by pulmonary pulse pressure (SV/PP) and prospectively gathered data on IPAH patients who underwent a right heart catheterization. SV/PP was analyzed as a predictor of mortality after adjusting for other modifiers of risk.
RESULTS: During 4-year follow-up of 104 patients, 21 patients died. When compared with conventional markers, SV/PP was the strongest univariate predictor of mortality (hazard ratio 17.0 per ml·mm Hg–1 decrease, 95% confidence interval 13.0 to 22.0; p < 0.0001). In successive bivariate analysis, SV/PP was the only predictor of mortality. In quartile analysis, the lowest SV/PP quartile had a 4-year mortality of 61%; the highest SV/PP had no deaths.
CONCLUSIONS: The capacitance index (SV/PP) is a strong independent predictor of mortality in patients with IPAH.
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Abbreviations and Acronyms
| | CI = confidence interval | | FEV-1 = one-second forced expiratory volume | | HR = hazard ratio | | IPAH = idiopathic pulmonary arterial hypertension | | NIH = National Institutes of Health | | PA = pulmonary artery | | PP = pulse pressure | | PVR = pulmonary vascular resistance | | RA = right atrium | | RV = right ventricle | | SV = stroke volume |
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