Non-invasively assessed pulmonary artery systolic pressure predicts short-term rehospitalizations in acute dyspnea patients

Abstract

Introduction: Pulmonary hypertension (PH) is common among patients with heart failure (HF) and predicts worse outcomes. PH may also occur in patients with pulmonary and other diseases causing chronic or acute dyspnea. Significance of non-invasively diagnosed PH in predicting readmissions in the so called "vulnerable phase" (30 days after index hospitalization) has not been analysed. Objective: To investigate the prognostic value of non-invasively assessed PASP for rehospitalizations (RH) at follow up of 30 days in patients with acute dyspnea. Design and Methods: During the period of 32 months 1482 acutely dyspneic patients were prospectively enrolled in the observational cohort study in two university hospitals. Causes of acute dyspnea were acutely decompensated HF, exacerbation of COPD, pneumonia, pulmonary embolism (PE) and others. In the first 48 hours after admission echocardiography was performed in 482 (32.5%) patients. Patients were divided in two groups: having PASP < 40 mmHg (no and mild PH) and with PASP = 40 mmHg (moderate and severe PH). Hazard ratio was adjusted to gender, age, LVEF and causes of dyspnea. Results: Of 482 examined patients (mean age 68.6±12.9 years) 193 (40.0%) were female. 64% had acute HF, 6.9% PE. Pulmonary hypertension (PASP >25 mmHg) was detected in 69.3% (n = 334) of patients. Mean PASP was equal to 46.54±16.19 mmHg. The proportion of patients with PASP < 40 and = 40 mmHg was 56.6% (n = 273) and 43.4% (n = 209) respectively. Increased PASP = 40 mmHg was associated with higher rate of RH due to all and cardiac causes in 1-month period (Table 1). In 118 (24.5%) patients, first rehospitalization occured in the first 30 days after discharge, 88 (74.58%) of them were rehospitalized due to cardiac causes (HF 22.9%, atrial fibrillation 11.9%, acute coronary syndromes 5.9%, cerebrovascular diseases 5%, aortic stenosis 5%, PE 4.2%) and 30 (25.4%) due to non-cardiac causes (pneumoni. [...].