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Prognostic Value of Heart Rate and Systemic Blood Pressure in Pulmonary Arterial Hypertension

M. Bersohn

Shelley Shapiro


Michelle Turner

Glenna Traiger


Adaani Frost

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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Bersohn M, Shapiro S, Turner MP, Traiger M, Frost AE.
VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

BACKGROUNDWe hypothesized that a high resting heart rate (HR) and low systolic systemic blood pressure (SBP) would portend a worse prognosis in patients with pulmonary arterial hypertension (PAH), similar to patients with left ventricular dysfunction. We tested this hypothesis by analyzing survival and freedom from all-cause hospitalization (hosp) in the Registry to Evaluate Early And Long-term PAH Disease Management (REVEAL), a large ongoing prospective US-based observational study. 

METHODSFor each of 3 baseline variables, HR, SBP, and the ratio SBP/HR, patients age ≥ 19 at enrollment were divided into quintiles (Q). Kaplan Meier curves were calculated by Q for survival and for freedom from hosp.  The results for Q2-4 were similar and were combined in the final analysis. Log-rank analysis with a Bonferroni correction was used to assess differences.

RESULTSThe baseline 6 minute walk distance, right heart pressures and cardiac output were similar across Q of all 3 vital sign variables. The table shows mean ± SE percent survival and freedom from hosp at 1 year, with p values for comparisons to Q2-4.

 

 


Q1

Q2-4

Q5

SBP ≤102

>102 to ≤130

>130

HR ≤70

>70 to ≤95

>95

SBP/HR ≤1.2

>1.2 to ≤1.7

> 1.7

N

 

2693

2666

2657

Survival

Q1

Q2-4

Q5

86 ± 2 **

91 ± 1

91 ± 1

92 ± 1

91 ± 1

86 ± 2 **

84 ± 2 **

91 ± 1

92 ± 1

Freedom from hosp

Q1

Q2-4

Q5

63 ± 2 **

72 ± 1

74 ± 2

73 ± 2

72 ± 1

63 ± 2 *

61 ± 2 **

72 ± 1

76 ± 2 

*P < 0.01; **P < 0.001

CONCLUSIONSIn a large cohort of PAH patients, baseline HR, SBP, and SBP/HR predicted survival and freedom from hospitalization during the first year of follow-up despite the similarity of some traditional prognostic indicators in PAH across Q. Vital sign parameters HR > 95, SBP ≤ 102, or the ratio of SBP/HR ≤ 1.2 identified a high risk group of patients that might benefit from more intensive treatment.