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Original Research: Pulmonary Vascular Disease |

Prognostic Relevance of Pulmonary Arterial Compliance in Patients With Chronic Heart FailurePulmonary Arterial Compliance in Heart Failure

Paolo Pellegrini, MD; Andrea Rossi, MD; Michele Pasotti, MD; Claudia Raineri, MD; Mariantonietta Cicoira, MD; Stefano Bonapace, MD; Frank Lloyd Dini, MD; Pier Luigi Temporelli, MD; Corrado Vassanelli, MD; Rebecca Vanderpool, PhD; Robert Naeije, MD; Stefano Ghio, MD
Author and Funding Information

From the Department of Medicine (Drs Pellegrini, Rossi, Cicoira, Bonapace, and Vassanelli), Section of Cardiology, University of Verona, Verona, Italy; the Division of Cardiology (Drs Pasotti, Raineri, and Ghio), Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; the Cardiac, Thoracic, and Vascular Department (Dr Dini), University of Pisa, Pisa, Italy; the Division of Cardiology (Dr Temporelli), Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy; and the Department of Physiology (Drs Vanderpool and Naeije), Erasme Campus of the Free University of Brussels, Brussels, Belgium.

Correspondence to: Stefano Ghio, MD, Divisione di Cardiologia, Policlinico S. Matteo, Piazza Golgi 1, 27100 Pavia, Italy; e-mail: s.ghio@smatteo.pv.it


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1064-1070. doi:10.1378/chest.13-1510
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Background:  Reduced pulmonary arterial compliance (Ca) is a marker of poor prognosis in idiopathic pulmonary arterial hypertension. We tested the hypothesis that pulmonary arterial Ca could be a predictor of outcome in patients with chronic heart failure (CHF).

Methods:  We enrolled 306 patients with CHF due to systolic left ventricular dysfunction (sLVD) who underwent a clinically driven right-sided heart catheterization. Pulmonary arterial Ca was measured by the ratio between stroke volume and pulse pressure (SV/PP). The primary end point was cardiovascular death; secondary end point was the composite of cardiovascular death, urgent heart transplantation, and appropriately detected and treated episode of ventricular fibrillation.

Results:  An inverse relationship was observed between SV/PP and pulmonary vascular resistance, the mean resistance-compliance product (RC-time) being 0.30 ± 0.2 s. In patients with pulmonary capillary wedge pressure (PCWP) < 15 mm Hg, the mean RC-time was 0.34 ± 0.14 s, and in patients with PCWP ≥ 15 mm Hg it was 0.28 ± 0.22 s. Eighty-seven patients died in a follow-up period of 50 ± 32 months. At receiver operating characteristic curve analysis, the optimal prognostic cutoff point of SV/PP was 2.15 mL/mm Hg. An elevated (> 2.15) SV/PP was more strongly associated with survival than any other hemodynamic variable; it was associated with poor prognosis both in patients with high (P = .003) and in patients with normal pulmonary vascular resistance (P = .005).

Conclusions:  Pulmonary arterial Ca is a strong prognostic indicator in patients with CHF with sLVD. Most importantly, its prognostic role is retained in patients with normal pulmonary vascular resistance.

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