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Prevalence, determinants, and prognostic significance of pulmonary hypertension in elderly patients admitted with acute decompensated heart failure: a report from the BIO-HF Registry

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Abstract
Purpose: Pulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear. Methods: We prospectively evaluated 401 patients aged 75years (mean age 835years, 50% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient 30mmHg. The endpoint was all-cause mortality. Results: PHT was found in 280/401 patients (69%), including in 67% of patients with HF with reduced ejection fraction (HFrEF) and 73% of patients with HF with preserved ejection fraction (HFpEF) (P=0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65%; moderate: 67%; severe: 85%; P<0.01). After a mean follow-up of 405 +/- 399days, 118 patients (30%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.11, P<0.001), serum creatinine (HR 1.41, 95% CI 1.15-1.73, P<0.01), and PHT (HR 1.60, 95% CI 1.03-2.49, P<0.01) were independent predictors of all-cause mortality. Conclusion: In elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.
Keywords
heart failure, pulmonary hypertension, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, elderly, LEFT-VENTRICULAR DYSFUNCTION, PRESERVED EJECTION FRACTION, ARTERY SYSTOLIC PRESSURE, NONINVASIVE EVALUATION, MORTALITY, ECHOCARDIOGRAPHY, REGURGITATION, COMMUNITY

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Chicago
Vanhercke, Daniel, Sofie Pardaens, Caroline Weytjens, Barbara Vande Kerckhove, Nancy De Laet, Emilie Janssens, Guy Van Camp, and Johan De Sutter. 2015. “Prevalence, Determinants, and Prognostic Significance of Pulmonary Hypertension in Elderly Patients Admitted with Acute Decompensated Heart Failure: a Report from the BIO-HF Registry.” Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques 32 (9): 1333–1338.
APA
Vanhercke, D., Pardaens, S., Weytjens, C., Vande Kerckhove, B., De Laet, N., Janssens, E., Van Camp, G., et al. (2015). Prevalence, determinants, and prognostic significance of pulmonary hypertension in elderly patients admitted with acute decompensated heart failure: a report from the BIO-HF Registry. ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, 32(9), 1333–1338.
Vancouver
1.
Vanhercke D, Pardaens S, Weytjens C, Vande Kerckhove B, De Laet N, Janssens E, et al. Prevalence, determinants, and prognostic significance of pulmonary hypertension in elderly patients admitted with acute decompensated heart failure: a report from the BIO-HF Registry. ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES. 2015;32(9):1333–8.
MLA
Vanhercke, Daniel, Sofie Pardaens, Caroline Weytjens, et al. “Prevalence, Determinants, and Prognostic Significance of Pulmonary Hypertension in Elderly Patients Admitted with Acute Decompensated Heart Failure: a Report from the BIO-HF Registry.” ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES 32.9 (2015): 1333–1338. Print.
@article{6870454,
  abstract     = {Purpose: Pulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear. 
Methods: We prospectively evaluated 401 patients aged 75years (mean age 835years, 50\% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient 30mmHg. The endpoint was all-cause mortality. 
Results: PHT was found in 280/401 patients (69\%), including in 67\% of patients with HF with reduced ejection fraction (HFrEF) and 73\% of patients with HF with preserved ejection fraction (HFpEF) (P=0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65\%; moderate: 67\%; severe: 85\%; P{\textlangle}0.01). After a mean follow-up of 405 +/- 399days, 118 patients (30\%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95\% confidence interval [CI] 1.03-1.11, P{\textlangle}0.001), serum creatinine (HR 1.41, 95\% CI 1.15-1.73, P{\textlangle}0.01), and PHT (HR 1.60, 95\% CI 1.03-2.49, P{\textlangle}0.01) were independent predictors of all-cause mortality. 
Conclusion: In elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.},
  author       = {Vanhercke, Daniel and Pardaens, Sofie and Weytjens, Caroline and Vande Kerckhove, Barbara and De Laet, Nancy and Janssens, Emilie and Van Camp, Guy and De Sutter, Johan},
  issn         = {0742-2822},
  journal      = {ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES},
  keyword      = {heart failure,pulmonary hypertension,heart failure with reduced ejection fraction,heart failure with preserved ejection fraction,elderly,LEFT-VENTRICULAR DYSFUNCTION,PRESERVED EJECTION FRACTION,ARTERY SYSTOLIC PRESSURE,NONINVASIVE EVALUATION,MORTALITY,ECHOCARDIOGRAPHY,REGURGITATION,COMMUNITY},
  language     = {eng},
  number       = {9},
  pages        = {1333--1338},
  title        = {Prevalence, determinants, and prognostic significance of pulmonary hypertension in elderly patients admitted with acute decompensated heart failure: a report from the BIO-HF Registry},
  url          = {http://dx.doi.org/10.1111/echo.12857},
  volume       = {32},
  year         = {2015},
}

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