NEWS & PERSPECTIVE
Recalibrating pulmonary vascular resistance to predict heart failure
In patients with pulmonary hypertension, an elevated pulmonary vascular resistance (PVR) of 3.0 Wood units (WU) or more has been known to be associated with poor clinical prognosis.1 In a recent study published in The Lancet Respiratory Medicine, a PVR of 2.2 WU appeared to be capable of independently predicting major clinical events of mortality and heart failure (HF) hospitalization.1 With a lower PVR value limit now found to be likely abnormal and clinically meaningful, the hemodynamic parameters that are currently used to define pulmonary hypertension clinically in patients with cardiopulmonary disease may require reconsideration.1
HF is the most common cause of death in patients who suffer from pulmonary arterial hypertension (PAH).2 Where patients with a mean pulmonary artery pressure (mPAP)
To evaluate the relationship between PVR and adverse clinical outcomes in PH, a retrospective cohort study has recruited 40,082 veterans from the Veterans Affairs Clinical Assessment, Reporting, and Tracking (VA-CART) Program who had right-heart catheterization (RHC) in the VA system from October 1, 2007 to September 30, 2016.4 The primary cohort consisted of 96.7% male with a median age of 66.5 years.1 The median follow-up was 1,153 days which included patients with a history of HF (23,201 [57.9%]), chronic obstructive pulmonary disease (13,348 [33.3%]), and those who were at risk of pulmonary hypertension based on a mPAP
When modeled as a continuous variable, the all-cause mortality hazard for PVR was found to increase at around 2.2 WU compared with PVR of 1.0 WU.1 Among patients with an mPAP
Based on the study results, the greatest increase in all-cause mortality HR emerged at around 2.2 WU.1 From a clinical perspective, while an elevated PVR of
By widening the continuum of clinical risk for mortality and HF in patients with elevated pulmonary artery pressure referred for RHC to include those with PVR
- Maron B A et al. Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study. Lancet Respir Med. 2020; 8: 873-884.
- Pulmonary Hypertension News. Pulmonary Hypertension and Heart Failure. https://pulmonaryhypertensionnews.com/pulmonary-hypertension-heart-failure/. Accessed September 25, 2020.
- Rosenkranz S et al. Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Eur Respir Rev. 2015; 24: 642–652.
- Kirkner R M et al. PVR reassessed as predictor of heart failure. CHEST Physician. 2020; 1-4.
Self-care is the key in the management of chronic heart failure
Heart failure (HF) is a commonly occurring disease affecting numerous patients worldwide. The rates of new HF hospitalization among the Chinese population in Hong Kong between 2005 and 2012 were 0.59 in every 1,000 males and 0.58 in every 1,000 females.1 Prognosis in relation to all-
2019 ESC guidelines on chronic coronary syndromes
The new European Society of Cardiology (ESC) guidelines for the diagnosis and management of chronic coronary syndromes (CCS) were presented at the ESC congress 2019 in Paris, France. These new guidelines, which updated those published in 2013, have been revised to focus on CCS instead
Cardioprotective benefits of diabetic drug dapagliflozin in patients with cardiovascular risk
The cardiovascular (CV) benefits of the diabetes mellitus (DM) drug dapagliflozin have been observed in the DECLARE-TIMI 58 trial. Dapagliflozin extends its benefits in type 2 DM (T2DM) patients with a wide spectrum of atherosclerotic cardiovascular disease (ASCVD).1