Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece.
Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Respir Med. 2024 Nov-Dec;234:107817. doi: 10.1016/j.rmed.2024.107817. Epub 2024 Sep 23.
Pulmonary hypertension associated with left heart disease (PH-LHD) prevalence ranges significantly across studies with limited real-world evidence.
To investigate the prevalence and prognostic influence of PH-LHD in a nationwide sample.
Using the 2018 US Nationwide Inpatient Sample we calculated the prevalence of PH across heart failure (HF), cardiomyopathies, aortic, and mitral valve disease. We used logistic regression to assess the impact of PH on LHD and to find significant contributors to in-hospital mortality in the PH-LHD population.
Among 6,270,625 hospitalizations with LHD, 801,535 (12.8 %) had a secondary PH diagnosis. PH-LHD prevalence was 17.2 % in HF with preserved ejection fraction (HFpEF), 11.8 % in HF with reduced ejection fraction (HFrEF), 16.8 % in dilated cardiomyopathy, 12.6 % in hypertrophic cardiomyopathy, 18.7 % in mitral regurgitation, 28.5 % in mitral stenosis, 13.5 % in aortic stenosis, and 13.9 % in aortic regurgitation. PH was associated with increased in-hospital mortality in HFpEF (OR 1.23; 95%CI 1.17-1.28), hypertrophic cardiomyopathy (1.42; 1.06-1.89), mitral regurgitation (1.17; 1.07-1.28), and aortic stenosis (1.14; 1.04-1.26), but not in HFrEF (1.04; 0.99-1.10), or dilated cardiomyopathy (1.13; 0.99-1.29). Among PH-LHD, in-hospital mortality was associated with age, atrial fibrillation/flutter, cancer, and acute cardiac (acute right HF, myocardial infarction, ventricular arrhythmia), or extra-cardiac (stroke, sepsis, pneumonia, acute renal failure, venous thromboembolism) diagnoses.
In a nationwide inpatient analysis the prevalence of PH-LHD was lower than previously reported indicating reduced recognition of this disease in real world clinical practice. The diagnosis of PH-LHD was associated with worse fatality rates across all forms of LHD, except for HFrEF.
左心疾病相关肺动脉高压（PH-LHD）的患病率在不同研究中差异显著，而真实世界的数据有限。
在全国性样本中调查 PH-LHD 的患病率和预后影响。
我们使用 2018 年美国全国住院患者样本，计算了心力衰竭（HF）、心肌病、主动脉瓣和二尖瓣疾病中 PH 的患病率。我们使用逻辑回归评估 PH 对 LHD 的影响，并确定 PH-LHD 人群住院死亡率的显著影响因素。
在 6270625 例 LHD 住院患者中，有 801535 例（12.8%）有继发性 PH 诊断。HF 射血分数保留（HFpEF）中 PH-LHD 的患病率为 17.2%，HF 射血分数降低（HFrEF）中为 11.8%，扩张型心肌病中为 16.8%，肥厚型心肌病中为 12.6%，二尖瓣反流中为 18.7%，二尖瓣狭窄中为 28.5%，主动脉瓣狭窄中为 13.5%，主动脉瓣反流中为 13.9%。PH 与 HFpEF（OR 1.23；95%CI 1.17-1.28）、肥厚型心肌病（1.42；1.06-1.89）、二尖瓣反流（1.17；1.07-1.28）和主动脉瓣狭窄（1.14；1.04-1.26）患者的院内死亡率增加相关，但与 HFrEF（1.04；0.99-1.10）或扩张型心肌病（1.13；0.99-1.29）患者无关。在 PH-LHD 患者中，院内死亡率与年龄、心房颤动/扑动、癌症和急性心脏（急性右心衰竭、心肌梗死、室性心律失常）或心脏外（中风、脓毒症、肺炎、急性肾衰竭、静脉血栓栓塞）诊断相关。
在全国性住院患者分析中，PH-LHD 的患病率低于之前的报告，表明在真实世界的临床实践中，这种疾病的识别率降低。PH-LHD 的诊断与所有形式的 LHD 患者的死亡率增加相关，除了 HFrEF 患者。
