Background
Methods
Study population and WHO classification
Echocardiography
Study outcomes
Statistical analysis
Results
Baseline characteristics
Total study population | Group I (PAH) | Group II (PH-LHD) | Group III (PH-Lung) | Group IV (CTEPH) | Group V (PH-Miscellaneous) | |
---|---|---|---|---|---|---|
(n = 2185) | (n = 333) | (n = 1189) | (n = 335) | (n = 102) | (n = 226) | |
Age (years) | 67.7 ± 14.9 | 56.5 ± 17.6 | 70.0 ± 13.6 | 72.5 ± 10.6 | 68.4 ± 14.8 | 64.4 ± 14.4 |
Female sex | 1123 (51.4%) | 227 (68.2%) | 611 (51.4%) | 110 (32.8%) | 71 (69.6%) | 104 (46.0%) |
BMI (kg/m2) | 22.9 ± 3.9 | 22.6 ± 4.5 | 23.1 ± 3.7 | 21.5 ± 3.9 | 24.9 ± 3.8 | 22.5 ± 3.5 |
Comorbidities | ||||||
Hypertension | 638 (29.2%) | 83 (24.9%) | 389 (32.7%) | 66 (19.7%) | 27 (26.5%) | 73 (32.3%) |
Diabetes mellitus | 611 (28.0%) | 45 (13.5%) | 385 (32.4%) | 63 (18.8%) | 17 (16.7%) | 101 (44.7%) |
Dyslipidemia | 288 (13.2%) | 26 (7.8%) | 200 (16.8%) | 25 (7.5%) | 13 (12.7%) | 24 (10.6%) |
CKD | 556 (25.4%) | 37 (11.1%) | 270 (22.7%) | 27 (8.1%) | 5 (4.9%) | 217 (96.0%) |
Chronic hepatitis | 307 (14.1%) | 18 (5.4%) | 202 (17.0%) | 58 (17.3%) | 10 (9.8%) | 19 (8.4%) |
Laboratory findings | ||||||
Hemoglobin (g/dL) | 11.8 ± 2.4 | 12.7 ± 2.8 | 11.7 ± 2.2 | 12.6 ± 2.4 | 12.1 ± 2.4 | 9.9 ± 1.9 |
Total cholesterol (mg/dL) | 154.9 ± 42.8 | 154.0 ± 41.6 | 155.5 ± 42.3 | 150.8 ± 41.6 | 172.2 ± 48.9 | 150.8 ± 44.2 |
Triglyceride (mg/dL) | 108.5 ± 66.6 | 111.7 ± 58.8 | 106.4 ± 61.6 | 99.6 ± 52.1 | 170.6 ± 149.3 | 102.0 ± 51.8 |
HDL-cholesterol (mg/dL) | 45.0 ± 14.4 | 46.2 ± 15.0 | 44.4 ± 13.9 | 48.1 ± 17.2 | 44.9 ± 15.1 | 44.5 ± 13.2 |
LDL-cholesterol (mg/dL) | 91.7 ± 33.3 | 95.9 ± 31.6 | 90.6 ± 33.0 | 87.3 ± 27.4 | 110.5 ± 38.7 | 91.1 ± 37.8 |
BUN (mg/dL) | 26.8 ± 19.9 | 18.1 ± 11.5 | 27.4 ± 18.8 | 19.3 ± 11.8 | 17.9 ± 7.8 | 51.2 ± 26.8 |
Creatinine (mg/dL) | 1.9 ± 2.6 | 1.1 ± 1.4 | 1.8 ± 2.1 | 1.0 ± 07 | 0.9 ± 0.7 | 5.9 ± 4.0 |
GFR (mL/min/1.73m2) | 80.6 ± 55.7 | 107.6 ± 56.7 | 75.2 ± 51.0 | 105.2 ± 53.5 | 108.2 ± 41.3 | 22.4 ± 24.7 |
HbA1c (%) | 6.5 ± 1.2 | 6.4 ± 1.2 | 6.5 ± 1.2 | 6.4 ± 0.9 | 6.5 ± 1.2 | 6.6 ± 1.4 |
Echocardiographic findings | ||||||
LVEDD (mm) | 51.0 ± 10.0 | 45.4 ± 8.5 | 54.2 ± 9.7 | 45.3 ± 8.2 | 44.9 ± 8.3 | 53.4 ± 7.9 |
LVESD (mm) | 35.6 ± 11.0 | 29.6 ± 8.5 | 39.0 ± 11.1 | 30.1 ± 8.6 | 30.1 ± 8.5 | 37.3 ± 9.4 |
LVEDV (mL) | 111.4 ± 61.7 | 86.1 ± 46.3 | 120.2 ± 62.5 | 83.1 ± 47.4 | 75.7 ± 39.6 | 81.9 ± 57.8 |
LVESV (mL) | 63.6 ± 50.4 | 41.5 ± 35.0 | 71.0 ± 52.0 | 42.5 ± 36.3 | 36.7 ± 31.6 | 81.9 ± 57.8 |
LVEF (%) | 52.5 ± 15.0 | 60.8 ± 8.4 | 47.7 ± 16.3 | 58.3 ± 11.0 | 61.4 ± 8.6 | 52.4 ± 12.7 |
LVMI (g/m2) | 121.8 ± 45.0 | 101.6 ± 42.2 | 131.6 ± 44.5 | 102.2 ± 39.7 | 98.3 ± 41.5 | 131.7 ± 37.8 |
LA dimension (mm) | 46.6 ± 12.1 | 41.9 ± 9.4 | 50.2 ± 12.3 | 39.2 ± 10.9 | 39.2 ± 9.3 | 48.2 ± 7.8 |
LAVI (mL/m2) | 71.9 ± 54.3 | 56.5 ± 36.8 | 78.1 ± 59.4 | 55.0 ± 36.9 | 51.0 ± 34.1 | 73.6 ± 40.3 |
Mitral inflow | ||||||
E velocity (m/sec) | 1.04 ± 0.51 | 0.80 ± 0.38 | 1.20 ± 0.53 | 0.76 ± 0.38 | 0.70 ± 0.41 | 1.09 ± 0.35 |
A velocity (m/sec) | 0.92 ± 5.40 | 0.74 ± 0.37 | 1.05 ± 7.89 | 0.84 ± 0.28 | 0.78 ± 0.24 | 0.85 ± 0.33 |
E/A ratio | 1.52 ± 2.55 | 1.11 ± 0.60 | 1.85 ± 1.25 | 1.27 ± 5.62 | 0.90 ± 0.65 | 1.49 ± 0.87 |
Deceleration time (msec) | 183.3 ± 92.0 | 188.7 ± 65.1 | 182.2 ± 103.6 | 186.0 ± 93.4 | 200.6 ± 73.0 | 169.7 ± 64.0 |
Mitral annular TDI | ||||||
e’ velocity (cm/sec) | 5.66 ± 2.18 | 6.06 ± 2.33 | 5.46 ± 2.15 | 5.97 ± 2.30 | 5.62 ± 1.80 | 5.66 ± 1.90 |
a’ velocity (cm/sec) | 7.77 ± 3.39 | 8.46 ± 3.11 | 6.58 ± 2.91 | 9.98 ± 3.98 | 9.36 ± 2.54 | 7.25 ± 2.73 |
s’ velocity (cm/sec) | 6.40 ± 2.91 | 7.05 ± 2.18 | 5.83 ± 2.27 | 7.39 ± 3.56 | 7.15 ± 2.40 | 6.42 ± 4.67 |
E/e’ ratio | 20.5 ± 12.8 | 14.7 ± 8.6 | 24.5 ± 13.9 | 14.2 ± 9.2 | 13.3 ± 8.7 | 21.1 ± 9.6 |
TR Vmax (m/sec) | 3.7 ± 0.3 | 3.8 ± 0.5 | 3.7 ± 0.3 | 3.7 ± 0.4 | 3.8 ± 0.4 | 3.7 ± 0.3 |
PASP (mmHg) | 65.5 ± 11.9 | 72.3 ± 18.1 | 62.3 ± 9.3 | 64.9 ± 10.8 | 65.6 ± 14.0 | 63.3 ± 7.9 |
Follow-up duration (months) | 32.4 (16.2–57.8) | 43.7 (25.3–64.0) | 34.6 (18.7–60.6) | 17.7 (2.2–38.7) | 29.0 (10.1–52.5) | 29.5 (16.0–52.1) |
All-cause death | 749 (34.3%) | 92 (27.6%) | 344 (28.9%) | 192 (57.3%) | 38 (37.3%) | 83 (36.7%) |
Echocardiographic parameters
Risk of mortality according to the PH subgroups
Risk factors for mortality and different prognostic profiles between PH subgroups
Total study population (n = 2185) | Group I PH (PAH; n = 333) | Group II PH (PH-LHD; n = 1189) | Group III PH (PH-Lung; n = 335) | Group IV PH (CTEPH; n = 102) | Group V PH (PH-Miscellaneous; n = 226) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Adjusted HR (95% CI) | P value | Adjusted HR (95% CI) | P value | Adjusted HR (95% CI) | P value | Adjusted HR (95% CI) | P value | Adjusted HR (95% CI) | P value | Adjusted HR (95% CI) | P value | |
Age > 70 years | 1.875 (1.390–2.529) | < 0.001 | 2.045 (1.299–3.219) | 0.002 | 1.997 (1.335–2.988) | 0.001 | 1.328 (0.976–1.808) | 0.071 | 2.660 (1.702–4.158) | < 0.001 | ||
Male sex | 1.674 (1.262–2.220) | < 0.001 | 1.765 (1.220–2.552) | 0.003 | 1.571 (1.000–2.467) | 0.050 | ||||||
BMI > 22.5 kg/m2 | 0.826 (0.630–1.082) | 0.165 | 0.727 (0.535–0.986) | 0.041 | ||||||||
Hypertension | 0.810 (0.592–1.110) | 0.190 | 0.645 (0.439–0.948) | 0.026 | ||||||||
DM | 0.864 (0.631–1.182) | 0.360 | ||||||||||
Dyslipidemia | 0.970 (0.643–1.463) | 0.884 | ||||||||||
Hemoglobin (per − 1 g/dL) | 1.072 (1.010–1.138) | 0.023 | 1.100 (1.011–1.195) | 0.026 | 1.135 (1.054–1.224) | 0.001 | 1.107 (1.040–1.181) | 0.002 | 1.145 (1.003–1.307) | 0.045 | ||
GFR < 60 mL/min/1.73m2 | 1.291 (0.936–1.790) | 0.120 | 1.689 (0.945–3.021) | 0.077 | ||||||||
LVEDV > 100 mL | 1.213 (0.890–1.654) | 0.221 | 1.514 (1.057–2.168) | 0.024 | ||||||||
LVEF < 30% | 1.058 ().693–1.616) | 0.794 | 1.514 (1.069–2.226) | 0.021 | ||||||||
LA dimension > 40 mm | 0.848 (0.618–1.162) | 0.305 | ||||||||||
PASP > 62 mmHg | 1.559 (1.188–2.047) | 0.001 | 1.671 (1.032–2.706) | 0.037 | 1.829 (1.346–2.485) | < 0.001 | 1.634 (1.215–2.197) | 0.001 | 1.916 (1.218–3.014) | 0.005 |
Medical expenditure and healthcare utilization
Total study population (n = 2185) | Group I (PAH) (n = 333) | Group II (PH-LHD) (n = 1189) | Group III (PH-Lung) (n = 335) | Group IV (CTEPH) (n = 102) | Group V (PH-Miscellaneous) (n = 226) | |
---|---|---|---|---|---|---|
Healthcare utilization | ||||||
Number of hospitalizations | 1 (0–4) | 2 (0–4) | 1 (0–4) | 1 (0–3) | 1 (0–2) | 2 (1–6) |
Total duration of hospitalization (days) | 9 (0–29) | 9 (0–27) | 10 (0–30) | 4 (0–24) | 2 (0–13) | 9 (1–42) |
Number of OPD visits | 15 (4–34) | 22 (9–43) | 15 (6–33) | 7 (1–23) | 12 (2–27) | 19 (5–43) |
Annualized rates of healthcare utilization | ||||||
Number of hospitalizations per year (events/person-year) | 0.4 (0.0–1.2) | 0.4 (0.0–1.1) | 0.4 (0.0–1.2) | 0.3 (0.0–1.1) | 0.2 (0.0–0.6) | 0.7 (0.2–1.6) |
Duration of hospitalization per year (days/person-year) | 2.3 (0.0–8.2) | 2.2 (0.0–6.8) | 2.7 (0.0–8.3) | 1.4 (0.0–8.9) | 0.5 (0.0–4.9) | 3.1 (0.4–10.9) |
Number of OPD visits per year (visits/person-year) | 4.6 (1.4–9.4) | 5.5 (2.6–10.0) | 4.6 (1.7–9.2) | 2.5 (0.4–8.2) | 4.0 (0.8–8.4) | 6.0 (1.8–12.1) |
Medical expenditurea | ||||||
Total costs ($USD) | 12,184 (3028–34,132) | 13,564 (4247–30,750) | 12,763 (2586–34,549) | 8086 (1834–27,482) | 5449 (2436–12,618) | 20,971 (5767–68,537) |
Cost for testing ($USD) | 4050 (1668–8560) | 4256 (2036–8311) | 4282 (1609–8706) | 3290 (1427–7127) | 2684 (1597–5630) | 5057 (1992–12,610) |
Cost for medications ($USD) | 422 (129–1272) | 598 (176–1935) | 409 (123–1187) | 296 (119–823) | 283 (93–950) | 493 (155–1868) |
Annual medical expenditure | ||||||
Total costs per year ($USD/person-year) | 3531 (949–10,708) | 3179 (1175–7910) | 3641 (829–10,924) | 3123 (792–10,092) | 1749 (808–5181) | 5739 (2094–20,048) |
Cost for testing per year ($USD/person-year) | 1135 (452–2492) | 1017 (488–2072) | 1196 (440–2490) | 1070 (393–2397) | 785 (366–1735) | 1573 (594–3183) |
Cost for medications per year ($USD/person-year) | 110 (34–372) | 140 (42–479) | 105 (31–348) | 95 (35–298) | 81 (25–238) | 139 (43–690) |