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Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy

Sandra V. Abramson, MD; James F. Burke, MD; John J. Kelly Jr., MD; James G. Kitchen III, MD; Michael J. Dougherty, MD; Donald F. Yih, MD; Frank C. McGeehin III, MD; John W. Shuck, MD; and Thomas P. Phiambolis, MD
[+] Article, Author, and Disclosure Information

Grant Support: By the Lankenau Research Center for assistance in statistical analysis.

Requests for Reprints: James Burke, MD, Suite 356 Lankenau Medical Building East, 100 Lancaster Avenue west of City Line, Wynnewood, PA 19096.

Current Author Addresses: Dr. Abramson: Echocardiography Laboratory, Lankenau Hospital, 100 Lancaster Avenue west of City Line, Wynnewood, PA 19096.

Drs. Burke, Kelly, Kitchen, Dougherty, Yih, McGeehin, Shuck, and Phiambolis: Suite 356 Lankenau Medical Building East, 100 Lancaster Avenue west of City Line, Wynnewood, PA 19096.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(11):888-895. doi:10.7326/0003-4819-116-11-888
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Objective: To ascertain whether pulmonary hypertension, as assessed noninvasively by continuous-wave Doppler of tricuspid regurgitation, can be an important independent factor in the prognosis of patients with ischemic or idiopathic dilated cardiomyopathy.

Design: Cohort study of consecutive patients with dilated cardiomyopathy in whom follow-up was obtained on all survivors for 28 months.

Setting: Outpatient cardiology private practice office in a tertiary care center.

Patients: Consecutive sample of 108 patients who presented for a scheduled office visit during a 15-month period.

Measurements: M-mode, two-dimensional, and Doppler echocardiographic examinations were done on all patients at entry into the study and on survivors 1 year later. All examinations included extensive pulsed- and continuous-wave Doppler evaluation for tricuspid regurgitation.

Main Outcome Measures: Overall mortality, mortality due to myocardial failure, and hospitalization for congestive heart failure.

Results: Twenty-eight patients had a high velocity of tricuspid regurgitation (> 2.5 m/s), and 80 patients had a low velocity (≤ 2.5 m/s). After 28 months of follow-up, the mortality rate was 57% in patients with a high velocity compared with 17% in patients with a low velocity (difference of 40%, 95% Cl, 20% to 60%). Hospitalization for congestive heart failure occurred in 75% and 26% of patients, respectively (difference of 49%, Cl, 30% to 68%). Eighty-nine percent of patients with a high velocity either died or were hospitalized compared with only 32% of patients with a low velocity (difference of 57%, Cl, 42% to 72%). The peak velocity of tricuspid regurgitation was the only prognostic variable selected using stepwise logistic regression models for the three outcome events.

Conclusion: Noninvasive assessment of pulmonary hypertension using continuous-wave Doppler of tricuspid regurgitation can predict morbidity and mortality in patients with ischemic or idiopathic dilated cardiomyopathy.





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