Department of Medicine, University of California, San Francisco, USA.
Department of Cardiology, Medstar Washington Hospital Center, Washington, DC, USA.
Respir Med. 2020 Mar;163:105891. doi: 10.1016/j.rmed.2020.105891. Epub 2020 Feb 4.
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.
肺血管顺应性（PAC）是肺动脉高压（PH）患者预后的强有力血流动力学预测指标。其在种族/民族、性别和 PH 病因亚组中的价值尚不清楚。我们假设 PAC 与结局的相关性不会因世界卫生组织（WHO）PH 组、种族/民族或性别而有所不同。
我们对一家三级医院的肺动脉高压综合治疗中心诊断和管理的 PH 患者进行了回顾性研究（n=270）。从电子病历中提取人口统计学、诊断、治疗和结局数据。使用 Cox 比例风险模型在单变量和多变量模型中对从右心导管检查到事件的时间进行建模。我们的主要结局是全因死亡率，次要结局是 PH 住院。
队列的中位年龄为 56 岁（±14.6），67%为女性。在多变量 Cox 模型中，调整了显著协变量后，PAC 降低与全因死亡率（p=0.029）和 PH 住院（p=0.010）均独立且显著相关。未观察到 PAC 与种族、性别或 WHO 组之间存在显著交互作用。西班牙裔患者的住院显著独立相关（p=0.030），非裔美国人的全因死亡率呈增加趋势。WHOPH 组 2 与更频繁的住院相关（p=0.004）。
PAC 降低与 PH 患者的死亡率和住院独立相关，与种族、性别和 PH 亚组无关。需要进一步研究以描述 PH 中种族差异的影响和决定因素。
