Author + information
- Francesca Bursi, MD, MSc,
- Sheila M. McNallan, MPH,
- Margaret M. Redfield, MD,
- Vuyisile T. Nkomo, MD, MPH,
- Carolyn S.P. Lam, MBBS,
- Susan A. Weston, MS,
- Ruoxiang Jiang, BS and
- Véronique L. Roger, MD, MPH⁎ ()
- ↵⁎Mayo Clinic, Division of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 55905
We thank Drs. Farmakis and Aessopos for the opportunity to clarify important aspects of the prognostic use of pulmonary artery systolic pressure (PASP) measured by Doppler in patients with heart failure (1). Although Doppler is the preferred tool to measure pulmonary pressures in practice (2), we agree that the estimation of right atrial pressure has limitations (3).
The upper limit of normal of 2.7 m/s corresponding to a peak gradient of 30 mm Hg was tested in a small group of younger (mean age 38.9 ± 12.7 years), healthy, nonsmoking subjects (4). Thus, it is applicable to similar, relatively young populations such as patients with beta-thalassemia or pulmonary arterial hypertension and when right atrial pressure is thought to be normal (5). Hence, this cutoff is of less relevance in older populations with greater comorbidity, as PASP increases with age, and patients with heart failure are elderly. Because there is no universally accepted cutoff value to define pulmonary hypertension, we analyzed the entire distribution of pulmonary pressures and analyzed PASP with tertiles or continuously, rather than applying an arbitrary cutoff. We showed that the higher the PASP, the worse the prognosis, and the estimation of right atrial pressure has no bearing on this continuum of risk.
We defined heart failure by epidemiological criteria, and our goal was not to distinguish the acute increase in filling pressures from the chronic passive or active component of pulmonary hypertension. We demonstrated that Doppler estimation of PASP was feasible in most patients (91%) in the community and that when elevated, it strongly and independently predicted outcome regardless of the mechanism of pulmonary hypertension.
Finally, although ejection fraction is an imperfect tool to measure systolic function, it is the most validated method, is widely available, and is recommended by all guidelines.
- American College of Cardiology Foundation
- Bursi F.,
- McNallan S.M.,
- Redfield M.M.,
- et al.
- Galie N.,
- Hoeper M.M.,
- Humbert M.,
- et al.,
- ESC Committee for Practice Guidelines (CPG)