Chest
Original ResearchPulmonary Vascular DiseaseDiastolic Pulmonary Vascular Pressure Gradient: A Predictor of Prognosis in “Out-of-Proportion” Pulmonary Hypertension
Section snippets
Patients and End Points
Between May 1996 and March 2003, 3,107 patients underwent a first diagnostic right-sided heart catheterization (RHC) at the Medical University of Vienna, a national PH referral center (Fig 1). In 2,524 patients (81.2%), the procedure was combined with a left-sided heart catheterization. Catheterizations were performed for various indications, mostly for the diagnosis of elevated systolic pulmonary arterial pressure (sPAP) at echocardiography, in patients with chronic heart failure and patients
Patients
Two thousand three hundred fifty-one complete data sets were collected in 3,107 patients (Fig 2). Fourteen patients were lost to follow-up. At inclusion, 30.6% of patients were in World Health Organization functional class 1, 34.3% in class 2, 25% in class 3, and 10.1% in class 4. One thousand three hundred eighty-nine patients were diagnosed as having PH (mPAP ≥ 25 mm Hg). Cases with PH associated with congenital heart disease (n = 130), and cases with multifactorial PH (n = 28) (Fig 2) were
Discussion
PH due to LHD is a common entity and carries a poor outcome.22, 23 Today, in developed countries, it is mainly due to systolic24 and diastolic left ventricular dysfunction10 and less commonly due to valvular heart disease.25 Chronic sustained elevation of pressure in pulmonary capillaries leads to vascular remodeling that resembles the classic pulmonary arteriopathy of precapillary PH.26 However, PH due to LHD is less frequently associated with intimal proliferation and plexiform lesions, and
Acknowledgments
Author contributions: Dr Lang is the guarantor of the entire manuscript.
Mr Gerges: contributed to the database, statistical analyses, histology, and writing of the manuscript.
Dr Gerges: contributed to the database, statistical analyses, histology, and writing of the manuscript.
Ms Lang: contributed to the database, statistical analyses, and approving the manuscript.
Dr Zhang: contributed to the histology and histological images and proofread the manuscript.
Dr Jakowitsch: contributed to the
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Funding/Support: This research was supported by the Austrian fellowship grant Medizinisch-Wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wien [Project No. 08080-2009] and by an educational grant from United Therapeutics Corporation.
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