Clinical Research
Systemic and Pulmonary Hypertension
Relationship of Pulmonary Arterial Capacitance and Mortality in Idiopathic Pulmonary Arterial Hypertension

https://doi.org/10.1016/j.jacc.2005.09.054Get rights and content
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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−1decrease, 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.

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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