Clinical Investigations Pulmonary Hypertension, Right Ventricular Function, and Clinical Outcome in Acute Decompensated Heart Failure

ABSTRACTBackground: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction have been associatedwith adverse outcome in patients with chronic heart failure. However, data are lacking in the setting ofacute decompensated heart failure (ADHF). We sought to determine prognostic significance of PH in pa-tients with ADHF and its interaction with RV function.Methods: We studied 326 patients with ADHF. Pulmonary artery systolic pressure (PASP) and RV func-tion were determined with the use of Doppler echocardiography, with PH defined as PASP O50 mm Hg.The primary end point was all-cause mortality during 1-year follow-up.Results: PH was present in 139 patients (42.6%) and RV dysfunction in 83 (25.5%). The majority ofpatients (70%) with RV dysfunction had PH. Compared with patients with normal RV function and with-out PH, the adjusted hazard ratio (HR) for mortality was 2.41 (95% confidence interval [CI] 1.44e4.03;P 5 .001) in patients with both RV dysfunction and PH. Patients with normal RV function and PH had anintermediate risk (adjusted HR 1.78, 95% CI 1.11e2.86; P 5 .016). Notably, patients with RV dysfunctionwithout PH were not at increased risk for 1-year mortality (HR 1.04, 95% CI 0.43e2.41; P 5 .94). PHand RV function data resulted in a net reclassification improvement of 22.25% (95% CI 7.2%e37.8%;P 5 .004).Conclusions: PH and RV function provide incremental prognostic information in ADHF. The combina-tion of PH and RV dysfunction is particularly ominous. Thus, the estimation of PASP may be warranted inthe standard assessment of ADHF. (J Cardiac Fail 2013;19:665e671)Key Words: Acute heart failure, prognosis, pulmonary hypertension, right ventricle.