Elevated Pulmonary Artery Pressure: Discussion (Part 1)
The data presented herein demonstrate that among a cohort of patients with a high prevalence of hypertension and LVH, important prognostic information was contained in the measurement of the hemodynamics of the pulmonary circulation. Across a wide spectrum of functional and structural cardiac abnormalities, pulmonary pressure appeared as the strongest predictor of mortality, entirely independent of the severity of coronary atherosclerosis, level of LVEF, and the degree of LVH. This predictive power was apparent among patients with both a normal and depressed LVEF, and patients with increased as well as normal LV mass, as determined by echocardiography. At each level of coronary disease, from patients without obstructive lesions to those with multivessel disease, higher pulmonary pressures were found among patients who died during follow-up. Based on relative risk estimates from multivariate regression analysis, an increase in PAMP of 10 mm Hg resulted in more than a fourfold increase in mortality. ampicillin antibiotic
Early studies of the survival determinants after cardiac catheterization demonstrated that global systolic LV function, as measured by ejection fraction, was highly predictive of survival. It has subsequently been recognized, however, that the information captured by the level of ejection fraction is essentially dichotomous; knowledge of LVEF has little prognostic value in patients with normal LV function (ie, LVEF>50 percent), likewise within the group of patients with a severely reduced LVEF, the absolute level of ejection fraction does not consistently contribute additional predictive power.