Quantitative Doppler-Echocardiographic Imaging and Clinical Outcomes with Left Ventricular Systolic Dysfunction: Independent Impact of Pulmonary Hypertension
Background-Doppler-echocardiography (D-E) provides quantitative imaging of systolic and diastolic left ventricular (LV) function, functional mitral regurgitation (FMR), and pulmonary hypertension (PH), in patients with LV systolic dysfunction (LVSD). Whether PH is linked to survival independently of LV features and FMR in symptomatic and asymptomatic patients is unknown.
Methods and Results—Patients with LVEF ≤ 40% and quantitative D-E assessment of FMR and PH were studied. Patients were frequency matched for those with D-E estimated pulmonary systolic pressure (PSP) ≥ 45 mmHg (N=692) and those without PH (N=692, PSP <45mmHg)) for age, gender, LVEF, and quantified FMR severity, and analyzed for long-term survival after diagnosis. During follow-up (median 8.9 years), 885 deaths (63.5%) occurred with PH being associated with higher 5-year mortality: 51 ± 2% vs 37 ± 2%, p < 0.001. In multivariate analysis, PH demonstrated increased mortality risk independent of age, gender, severity of diastolic and systolic LV dysfunction, FMR, co-morbidities, and symptom (HR 1.34, 95% CL 1.17-1.53, p < 0.001). Subgroup analysis, stratified by symptoms, degree of FMR, and severity of LV dysfunction demonstrated that PH was associated with excess mortality in all subgroups.
Conclusions—In this large cohort of LVSD patients, in whom FMR and LV characteristics were quantified and matched between those with and without PH, the presence of PH was an independent factor for excess mortality, and not a surrogate for the severity of LVSD or FMR. In asymptomatic or symptomatic patients with or without FMR, PH is a critical marker for poor outcomes.
- Received September 12, 2013.
- Accepted January 28, 2014.