Author + information
- Cihangir Kaymaz,
- Aykun Hakgor,
- Hacer Ceren Tokgoz Demircan,
- Ozgur Akbal,
- Ibrahim Halil Tanboga,
- Fatih Yilmaz,
- Canan Elif Yildiz,
- Sevim Turkday,
- Nertila Poci,
- Tugba Aktemur,
- Durmus Demir,
- Seda Tanyeri and
- Nihal Ozdemir
Background: Diastolic pressure gradient (DPG) is proposed as a novel measure of pulmonary arterial (PA) hemodynamics being minimally influenced by changes in stroke volume as compared to PA pulse pressures (PAPP) and transpulmonary pressure gradient (TPG). However, correlates and prognostic value of these measures remain to be determined.
Methods: In this single-center study, we assessed the correlates and prognostic impact of DPG, TPG and PAPP in 481 patients (pts) (F:296, age 49,2 ±18,2yrs) with pulmonary hypertension (PH). Subgroups were as follows: Idiopathic PA hypertension (IPAH) (n=102), PAH associated with congenital heart disease (APAH-CHD) (n=166), other PAH (n= 25), combined pre- and post-capillary PH (n=15), Group 3 PH (n=56) and Group 4 PH (n=108).
Results: Median functional class (FC) was 3 and six-minute walk distance (6MWD) was 279 (180-360) m at diagnosis. Baseline PA mean and right atrial pressure (RAP) were 54.4±22 and 10±5.6 mmHg, respectively. Mean PAPP, TPG and DPG were 53.6±20.3, 42±22 and 20 (10-35) mmHg, and pulmonary and systemic vascular resistance (PVR, SVR) and PVR/SVR ratio were 7.6 (4.5-12.7) WU, 20.4 (16-26) WU and 0.37 (0.23-0.60), respectively. Targeted treatments were noted in 294 pts. Median survival (SV, months) was 83.9 in overall PH and 91.4 in PAH groups. Baseline DPG and TPG were highly correlated (r = 0.91, p<0.001) whereas DPG compared to TPG showed weaker correlation to PAPP (r = 0.33 vs 0.61) (p< 0,001 for both). Both DPG and TPG were correlated with PVR (r=0.73 and 0.81), PVR/SVR ratio (r=0.75 and 0.81), 6MWD (r=0.18 and 0.12, p=0.001 and 0.026) and oxyhemoglobin saturation (SatO2%) (r= − 0.20 and – 0.27) (p=0.002 and<0.001), but not with FC. PAPP showed moderate correlation to PVR (r = 0.50, p<0.0001). Baseline cardiac index, DPG, TPG, or DPG cut-off (>7 mmHg) were not associated with SV (p=NS). In multivariate analysis, baseline FC, PVR and clinical worsening episodes (CW) were associated with SV (p<0.05).
Conclusions: Despite high concordance between DPG and TPG, DPG was less likely to be related with PAPP. Both DPG and TPG were correlated with PVR, PVR/SVR, 6MWD and SatO2%, but not with FC. Only baseline FC, PVR and CW were independent predictors of SV.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Predicting the Future: Observations and Discoveries From Registries and Databases
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1230-006
- 2017 American College of Cardiology Foundation