Pulmonary hypertension (PH) is usually perceived as a complication of established
heart failure (HF) rather than as a predictor of HF or a marker of subclinical HF.
PH may develop because of cardiac alterations that result in increased filling pressures
after acute myocardial infarction (AMI). We hypothesized that PH might be a useful
marker to predict the risk of HF after AMI. We studied 1,054 patients with AMI. Pulmonary
artery systolic pressure (PASP) was estimated using echocardiography at the index
admission and PH was defined as a PASP >35 mm Hg. The primary end point was readmission
for HF at 1 year. PH was present in 471 patients (44.6%) and was strongly associated
with age, decreased ejection fraction, advanced diastolic dysfunction, and moderate/severe
mitral regurgitation (p <0.0001 for all comparisons). Area under the receiver operating
characteristic curve was significantly higher for estimated PASP (0.74 ± 0.02) compared
to other echocardiographic parameters (p = 0.02 to 0.0003). After adjustments for
clinical and echocardiographic variables in a Cox model, PH was associated with a
hazard ratio of 3.10 for HF (95% confidence interval 1.31 to 2.57, p <0.0001). After
adding estimated PASP to a model containing clinical and echocardiographic risk factors,
net reclassification improvement was 0.21 (95% confidence interval 0.11 to 0.31, p
<0.0001). In conclusion, PASP integrates the severity of multiple hemodynamic determinants
of increased left atrial pressures that lead to an increase in pulmonary venous pressure.
In AMI, PH at the index admission is a useful marker in unmasking latent subclinical
HF and predicting the development of overt HF.
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Article info
Publication history
Published online: February 10, 2012
Accepted:
December 11,
2011
Received in revised form:
December 11,
2011
Received:
October 22,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
