Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure

Paolo Pellegrini, Andrea Rossi, Michele Pasotti, Claudia Raineri, Mariantonietta Cicoira, Stefano Bonapace, Frank Lloyd Dini, Pier Luigi Temporelli, Corrado Vassanelli, Rebecca Vanderpool, Robert Naeije, Stefano Ghio

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Reduced pulmonary arterial compliance (Ca) is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that pulmonary arterial Ca could be a predictor of outcome in patients with chronic heart failure (CHF). Methods: We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right-sided heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end point was cardiovascular death; secondary end point was the composite of cardiovascular death, urgent heart transplantation, and appropriately detected and treated episode of ventricular fi brillation. Results: An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 s. In patients with pulmonary capillary wedge pressure (PCWP) <15 mm Hg, the mean RC-time was 0.34 ± 0.14 s, and in patients with PCWP ≥ 15 mm Hg it was 0.28 ± 0.22 s. Eighty-seven patients died in a follow-up period of 50-32 months. At receiver operating characteristic curve analysis, the optimal prognostic cutoff point of SV/PP was 2.15 mL/mm Hg. An elevated ( > 2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high ( P = .003) and in patients with normal pulmonary vascular resistance ( P = .005). Conclusions: Pulmonary arterial Ca is a strong prognostic indicator in patients with CHF with sLVD. Most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance.

Original languageEnglish
Pages (from-to)1064-1070
Number of pages7
JournalChest
Volume145
Issue number5
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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