Elevated Pulmonary Artery Pressure: Discussion (Part 2)
The weak predictive power of LVEF within the normal range is perhaps not surprising; however, its insensitivity among patients with significant disease raises a series of interesting and important questions. It would appear that the loss of cardiac pump function that generates the risk of dying is not linearly related to systolic function and reflects a more complex interaction with other aspects of myocardial damage.
Several previous reports in patients with a reduced ejection fraction have proposed a prognostic role for the severity of hemodynamic abnormalities. In these studies, patients with a markedly depressed cardiac output and stroke work index, associated with an elevated LV filling pressure and high systemic vascular resistance, experienced a significantly worse prognosis than patients with near normal values for these hemodynamic variables. The significance of pulmonary pressures, however, has not been adequately assessed previously. The absence of a wide range of PAMP values and the limited sample size included in these previous studies may explain why the predictive value of PAMP was not identified. antibiotics levaquin
It is possible that the powerful independent predictive contribution of pulmonary hypertension to the survival analysis that we observed reflects primarily abnormalities of diastolic dysfunction and reduced LV compliance.