Highlights
- •PAC predicts mortality in patients with pulmonary arterial hypertension (PAH) and pulmonary hypertension due to left heart disease (PH-LHD).
- •A decrease in PAC by 1ml/mmHg from baseline or during follow-up significantly increases mortality risk in PAH and PH-LHD patients & vice-versa.
- •Treatment modalities targeted at PAC improvement can affect the overall survival and quality of life in such patients.
Abstract
Background
Pulmonary arterial capacitance or compliance (PAC) has been reported as an independent
predictor of mortality in patients with pulmonary arterial hypertension (PAH) and
pulmonary hypertension secondary to left heart disease (PH-LHD).
Methods
We conducted a literature search of PubMed/Medline, Google Scholar, and Cochrane library
databases from July 30th to September 4th, 2020, and identified all the relevant studies
reporting mortality outcomes in patients with PAH and PH-LHD. Pooled data from these
studies were used to perform a meta-analysis to identify the role of PAC in predicting
all-cause mortality in this subset of patients.
Results
Pooled data on 4997 patients from 15 individual studies showed that the mortality
risk in patients with PAH and PH-LHD varies significantly per unit change in PAC either
from baseline or during follow-up. A reduction in PAC per 1 ml/mmHg was associated
with a 4.25 times higher risk of all-cause mortality (95% CI 1.42–12.71; p = 0.021) in PAH patients. Among patients with PH-LHD, mortality risk increased by
~30% following a unit decrease in PAC (HR, 1.29; p = 0.019), whereas an increase in
PAC by 1 ml/mmHg lowered the mortality risk by 30% (HR, 0.70).
Conclusion
PAC is a strong and independent predictor of all-cause mortality in both patients
with PAH and PH-LHD. A decrease in PAC by 1 ml/mmHg from baseline or during follow-up
significantly increases the risk of all-cause mortality among both patients with PAH
and PH-LHD. Treatment modalities targeted at PAC improvement can affect the overall
survival and quality of life in such patients.
Keywords
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References
- Pulmonary vascular wall stiffness: an important contributor to the increased right ventricular afterload with pulmonary hypertension.Pulm Circ. 2011; 1: 212-223
- Definitions and diagnosis of pulmonary hypertension.J. Am. Coll. Cardiol. 2013; 62: D42-D50
- Mechanisms of disease: pulmonary arterial hypertension.Nat. Rev. Cardiol. 2011; 8: 443-455
- Pulmonary hypertension in heart failure: pathophysiology, pathobiology, and emerging clinical perspectives.J. Am. Coll. Cardiol. 2017; 69: 1718-1734
- Left ventricular heart failure and pulmonary hypertension.Eur. Heart J. 2016; 37: 942-954
- Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension.Int. J. Cardiol. 2017; 230: 53-58
- Pulmonary vascular resistance during exercise predicts long-term outcomes in heart failure with preserved ejection fraction.J. Card. Fail. 2018; 24: 169-176
- Pulmonary vascular resistance estimated by Doppler echocardiography predicts mortality in patients with interstitial lung disease.J. Cardiol. 2016; 68: 300-307
- Prognostic role of pulmonary arterial capacitance in advanced heart failure.Circ. Heart Fail. 2012; 5: 778-785
- The critical role of pulmonary arterial compliance in pulmonary hypertension.Ann. Am. Thorac. Soc. 2016; 13: 276-284
- Relationship of pulmonary arterial capacitance and mortality in idiopathic pulmonary arterial hypertension.J. Am. Coll. Cardiol. 2006; 47: 799-803
- The prognostic significance of pulmonary arterial capacitance in pulmonary arterial hypertension: single-center experience.Pulm Circ. 2016; 6: 608-610
- Longitudinal change in pulmonary arterial capacitance as an indicator of prognosis and response to therapy and in pulmonary arterial hypertension.Pulm Circ. 2017; 7: 399-408
- Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure.Chest. 2014; 145: 1064-1070
- The prognostic value of pulmonary vascular capacitance determined by Doppler echocardiography in patients with pulmonary arterial hypertension.J. Am. Soc. Echocardiogr. 2006; 19: 1045-1050
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6e1000097
- Society's Choices: Social and Ethical Decision Making in Biomedicine.National Academic Press (US), Washington (DC)1995
- Methodological index for non-randomized studies (minors): development and validation of a new instrument.ANZ J. Surg. 2003; 73: 712-716
- Cochrane Training. Chapter 10.3.: Analysing Data and Undertaking Meta-Analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.1 (updated September 2020). Cochrane, 2020..Cochrane, 2020 (www.training.cochrane.org/handbook)
- The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method.BMC Med. Res. Methodol. 2014; 14: 25
- Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.BMC Med. Res. Methodol. 2014; 14: 135
- How to perform a meta-analysis with R: a practical tutorial.Evid. Based Ment. Health. 2019; 22: 153-160
- J. Stat. Softw. 2010; 36: 1-48
- Hemodynamic predictors of survival in scleroderma-related pulmonary arterial hypertension.Am. J. Respir. Crit. Care Med. 2010; 182: 252-260
- Pulmonary arterial capacitance predicts clinical outcome in the patients with PH-LHD with preserved ejection fraction.J. Card. Fail. 2017; 23https://doi.org/10.1016/j.cardfail.2017.08.320
- Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure.J. Am. Coll. Cardiol. 2001; 37: 183-188
- Predictive value of pulmonary arterial compliance in systemic lupus erythematosus patients with pulmonary arterial hypertension.Hypertension. 2020; 76: 1161-1168
- Prognostic value of follow-up hemodynamic variables after initial Management in Pulmonary Arterial Hypertension.Circulation. 2018; 137: 693-704
- Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction.JACC Heart Fail. 2015; 3: 467-474
- Pulmonary arterial capacitance in patients with heart failure and reactive pulmonary hypertension.Eur. J. Heart Fail. 2015; 17: 74-80
- Pulmonary arterial capacitance predicts outcomes in patients with pulmonary hypertension independent of race/ethnicity, sex, and etiology.Respir. Med. 2020; 163: 105891
- Pulmonary arterial capacitance predicts cardiac events in pulmonary hypertension due to left heart disease.PLoS One. 2016; 11e0165603
- Prognostic value of hemodynamics and comorbidities in pulmonary hypertension due to advanced heart failure.Heart Lung. 2020; 49: 158-164
- Pulmonary effective arterial elastance as a measure of right ventricular afterload and its prognostic value in pulmonary hypertension due to left heart disease.Circ. Heart Fail. 2018; 11e004436
- Right ventricular oscillatory power is a constant fraction of total power irrespective of pulmonary artery pressure.Am. J. Respir. Crit. Care Med. 2010; 182: 1315-1320
- The arterial load in pulmonary hypertension.Eur. Respir. Rev. 2010; 19: 197-203
- Pulmonary arterial compliance in dogs and pigs: the three-element windkessel model revisited.Am. J. Phys. 1999; 277: H725-H731
- Determinants of right ventricular afterload (2013 Grover conference series).Pulm Circ. 2014; 4: 211-219
- RC time constant of single lung equals that of both lungs together: a study in chronic thromboembolic pulmonary hypertension.Am. J. Physiol. Heart Circ. Physiol. 2009; 297: H2154-H2160
- Pulmonary vascular resistance and compliance stay inversely related during treatment of pulmonary hypertension.Eur. Heart J. 2008; 29: 1688-1695
- Compliance of the human pulmonary arterial system in disease.Circ. Res. 1971; 29: 40-50
- Pulmonary capillary wedge pressure augments right ventricular pulsatile loading.Circulation. 2012; 125: 289-297
- Prostanoids but not oral therapies improve right ventricular function in pulmonary arterial hypertension.JACC Heart Fail. 2013; 1: 300-307
- Riociguat for the treatment of pulmonary arterial hypertension.N. Engl. J. Med. 2013; 369: 330-340
- Predictors of long-term outcomes in patients treated with riociguat for pulmonary arterial hypertension: data from the PATENT-2 open-label, randomised, long-term extension trial.Lancet Respir. Med. 2016; 4: 361-371
- EXPRESS: effect of riociguat on pulmonary arterial compliance in the PATENT and CHEST studies.Pulm Circ. 2020; 10
Article info
Publication history
Published online: February 19, 2021
Accepted:
February 12,
2021
Received in revised form:
January 20,
2021
Received:
December 4,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
