Elevated Pulmonary Artery Pressure: Results (Part 6)

Elevated Pulmonary Artery Pressure: Results (Part 6)The coexistence of both high LV mass and high PAMP carried a fivefold increase in mortality risk. The interaction between elevated pulmonary pressure and LVH was further examined by introducing a cross-product term (PA mean X LV mass) into the Cox regression model (Table 6). This term was highly significant in the univariate and multivariate models, and it eliminated the predictive value of both PAMP and LV mass entered separately.
Third, in an additional analysis, the sample was successively divided into (1) subjects with high and low PAMP at baseline, and the predictive value of LV mass was examined, and (2) subjects with high and low LV mass, and the predictive value of PAMP was tested (Table 6). An increased PAMP was strongly associated with the risk of dying in patients with high LV mass, but not in those with moderately increased or normal LV mass. Contrariwise, increases in LV mass were associated with a greater chance of dying in patients with mean pulmonary pressures equal to or greater than 20 mm Hg, but not in those with lower pressures. No interaction was noted between PAMP and LVEF (data not shown). Buy Advair Diskus Online
In summary, these last three analyses demonstrate the following: (1) the predictive value of increased PAMP is independent of the degree of CAD; (2) PAMP provides prognostic information independent of increases in LV mass and exhibits a strong positive interaction with worsening LVH; and (3) the interaction of PAMP and LV mass is independent of the effect of more severe CAD and LV dysfunction.

Table 6—The Interactive Effect of Increases in Pulmonary Artery Pressure and Left Ventricular Mass on Survival

Cox Regression Models on the Interaction of PA Pressure and LV
Mass
Univariate Model
Improvement
Variable X! p value
PA mean 28.1 .000
LV mass 9.0 .003
Ejection fraction 6.4 .012
No. of vessels 6.3 .012
PA mean x LV mass 37.0 .000
Multivariate Model
Standardized Improvement
Variable ^-Coefficient x! p value
PA mean X LV mass 5.47 22.7 .000
No. of vessels 1.89 3.5 .000
Multivariate Co* Regression Models in High and Low Bivariate
Distribution of PA Mean Pressure and LV Mass
Variable p value
High or low PA mean pressure*
High PA mean (a20 mm Hg) LV mass .041
Low PA mean (s 19 mm Hg) Ejection fraction .048
High or low LV masst
High LV mass (a 140 g/m) PA mean .000
Low LV mass (<140 g/m) (No variables)

Category: Pulmonary function

Tags: ejection fraction, hypertrophy, pulmonary artery pressure, pulmonary pressure, systolic function