Prevalence, risk factors, and survival associated with pulmonary hypertension and heart failure among patients with underlying coronary artery disease: a national prospective, multicenter registry study in China  

作　　者：Li Huang Lingpin Pang Qing Gu Tao Yang Wen Li Ruilin Quan Weiqing Su Weifeng Wu Fangming Tang Xiulong Zhu Jieyan Shen Jingzhi Sun Guangliang Shan Changming Xiong Shian Huang Jianguo He 

机构地区：[1]Department of Cardiology,Guangdong Cardiovascular Instute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou,Guangdong 510080,China [2]Cardiovascular Medicine Center,Afliated Hospital of Guangdong Medical University,Zhanjang,Guangdong 510180,China [3]Center of Pulmonary Vascular Disease,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100007,China [4]Department of Cardiology,Lianjang People's Hospital,Lianjang,Guangdong 524499,China [5]Department of Cardiology,the First Afliated Hospital of Guangxi Medical University,Naning,Guangxi 530021,China [6]Department of Cardiology,Nongken Central Hospital of Guangdong Province,Zhanjang,Guangdong 529632,China [7]Department of Cardiology,People's Hospital of Gaozhou,Gaozhou,Guangdong 525232,China [8]Department of Cardiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China [9]Department of Cardiology,ffliated Hospital of Jining Medical University,Jining,Shandong 272007,China [10]Department of pidemiology and Biostatistis,Insttute of Basic Medical Sciences,Chinese Academy of Medical Sciences,Scholf Basic Medicine,Peking Union Medial College,Beijing 100006,China

出　　处：《Chinese Medical Journal》2022年第15期1837-1845,共9页中华医学杂志（英文版）

基　　金：National Key Technology R&D Program of China(No. 2011BAI11B15);National Key Research and Development Program of China(No. 2016YFC1304400)。

摘　　要：Background: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH.Methods: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RHC), and other baseline clinical data were recorded. Patients were followed up and their survival was recorded.Results: One hundred and eighty-two CAD-HF patients were enrolled, including 142 with HF with a preserved ejection fraction (heart failure with preserved ejection fraction [HFpEF];left ventricular ejection fraction [LVEF] ≥50%) and 40 with a reduced ejection fraction (heart failure with reduced ejection fraction [HFrEF];LVEF < 50%). PH was diagnosed with RHC in 77.5% of patients. Patients with PH showed worse hemodynamic parameters and higher mortality. HFrEF-PH patients had worse survival than HFpEF-PH patients. CAD-HF patients with an enlarged left ventricular end-diastolic diameter and reduced hemoglobin were at higher risk of PH. Nitrate treatment reduced the risk of PH. Elevated creatinine and mean pulmonary arterial pressure (mPAP), diastolic pressure gradient (DPG) ≥7 mmHg, and previous myocardial infarction (MI) entailed a higher risk of mortality in CAD-HF patients with PH.Conclusions: PH is common in CAD-HF and worsens the hemodynamics and survival in these patients. Left ventricle enlargement and anemia increase the risk of PH in CAD-HF. Patients may benefit from nitrate medications. Renal impairment, elevated mPAP, DPG ≥7 mmHg, and previous MI are strong predictors of mortality in CAD-HF-PH patients.Trial Registration: ClinicalTrials.gov, NCT02164526.

关 键 词：Coronary artery disease Heart failure Pulmonary hypertension Registry study 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]