Article révisé par les pairs
| Résumé : | ABSTRACT BACKGROUND A reduced pulmonary arterial compliance (Ca) is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that Ca could be a predictor of outcome in patients with chronic heart failure (CHF). METHODS We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end-point was cardiovascular death; secondary end-point was the composite of cardiovascular death, urgent heart transplantation and appropriately detected and treated episode of ventricular fibrillation. RESULTS An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 seconds. In patients with pulmonary capillary wedge pressure < 15 mmHg the mean RC-time was 0.34 ± 0.14 sec and in patients with pulmonary capillary wedge pressure ≥ 15 mmHg it was 0.28 ± 0.22 sec. Eighty-seven patients died in a follow-up period of 50 ± 32 months. At receiver operating characteristic curve analysis, the optimal prognostic cut-off point of SV/PP was 2.15 ml/mmHg. An elevated (>2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high (p=0.003) and in patients with normal pulmonary vascular resistance (p=0.005). CONCLUSIONS Pulmonary arterial compliance is a strong prognostic indicator in CHF patients with sLVD; most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance. |
