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

Jacob J Mayfield; Alexander Papolos; Elena Vasti; Teresa De Marco; Geoffrey H Tison

doi:10.1016/j.rmed.2020.105891

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

Respir Med. 2020 Mar:163:105891. doi: 10.1016/j.rmed.2020.105891. Epub 2020 Feb 4.

Authors

Jacob J Mayfield¹, Alexander Papolos², Elena Vasti³, Teresa De Marco⁴, Geoffrey H Tison⁵

Affiliations

¹ Department of Medicine, University of California, San Francisco, USA.
² Department of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA.
³ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁴ Department of Medicine, University of California, San Francisco, USA; Division of Cardiology, University of California, San Francisco, USA.
⁵ Department of Medicine, University of California, San Francisco, USA; Division of Cardiology, University of California, San Francisco, USA; Bakar Institute of Computational Health Sciences, University of California, San Francisco, USA; Cardiovascular Research Institute, University of California, San Francisco, USA. Electronic address: geoff.tison@ucsf.edu.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Health disparities; Prognosis; Pulmonary arterial capacitance; Pulmonary hypertension.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cohort Studies
Female
Hospitalization / statistics & numerical data
Humans
Hypertension, Pulmonary / diagnosis*
Hypertension, Pulmonary / etiology
Hypertension, Pulmonary / mortality
Hypertension, Pulmonary / physiopathology*
Male
Middle Aged
Prognosis
Pulmonary Artery / physiopathology*
Racial Groups
Retrospective Studies
Sex Factors
Vascular Patency*

Grants and funding

K23 HL135274/HL/NHLBI NIH HHS/United States