Pulmonary arterial capacitance predicts outcomes in patients with pulmonary hypertension independent of race/ethnicity, sex, and etiology

• Published in: Respiratory medicine Vol. 163; p. 105891
• Main Authors: Mayfield, Jacob J., Papolos, Alexander, Vasti, Elena, De Marco, Teresa, Tison, Geoffrey H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2020; Elsevier Limited
• Subjects: Age; Asian Americans; Capacitance; Catheterization; Cohort Studies; Continental Population Groups; Diagnostic systems; Electronic health records; Electronic medical records; Ethnicity; Etiology; Female; Health disparities; Hemodynamics; Hispanic people; Hospitalization; Hospitalization - statistics & numerical data; Humans; Hypertension; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - physiopathology; Intubation; Laboratories; Male; Medical prognosis; Middle Aged; Minority & ethnic groups; Mortality; Patients; Prognosis; Pulmonary arterial capacitance; Pulmonary Artery - physiopathology; Pulmonary hypertension; Race; Race factors; Retrospective Studies; Sex; Sex Factors; Statistical models; Subgroups; Ultrasonic imaging; Vascular Patency; United States > US; San Francisco California; Prognosis; Pulmonary hypertension; Pulmonary arterial capacitance; Health disparities
• ISSN: 0954-6111; 1532-3064
• DOI: 10.1016/j.rmed.2020.105891

Pulmonary arterial capacitance (PAC) is a strong hemodynamic predictor of outcomes in patients with pulmonary hypertension (PH). Its value across subgroups of race/ethnicity, sex, and PH etiologies is unclear. We hypothesized that the association of PAC with outcomes would not vary across World Health Organization (WHO) PH group, race/ethnicity, or sex. We performed a retrospective study in patients with PH diagnosed and managed at the Pulmonary Hypertension Comprehensive Care Center of a tertiary care hospital (n = 270). Demographic, diagnostic, treatment, and outcome data were extracted from the electronic medical record. Cox proportional hazards models were used to model time from right heart catheterization to event in univariate and multivariable models. Our primary outcome was all-cause mortality and our secondary outcome was PH hospitalization. The median age of the cohort was 56 years (±14.6), and 67% were female. In multivariable Cox models adjusted for significant covariates, decreased PAC remained independently and significantly associated with both all-cause mortality (p = 0.029) and hospitalization for PH (p = 0.010). No significant interactions were observed between PAC and race, sex, or WHO group. Hispanic patients exhibited a significant independent association with increased hospitalizations (p = 0.030), and there was a trend toward increased all-cause mortality in African Americans. WHO group 2 PH was associated with more frequent hospitalization (p = 0.004). Decreased PAC is significantly associated with mortality and hospitalization in PH patients independent of race, sex, and PH subgroups. Further investigation is required to characterize the effects and determinants of racial disparities in PH. •Pulmonary arterial capacitance (PAC) predictors outcomes in pulmonary hypertension.•PAC is a univariate predictor of both mortality and hospitalization outcomes in this cohort.•Adjusted for other covariates, PAC significantly predicted mortality.•There were no significant interactions observed between PAC and race for mortality.•A 1 mL/mmHg reduction in PAC was associated with 30% increased risk of death.