Heart & lung : the journal of critical care · 2025
Association of borderline pulmonary artery wedge pressure with major cardiovascular events in patients with pulmonary hypertension and chronic kidney disease.
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Martinez Manzano Jose Manuel, Kosak Lopez Esteban, Geller Andrew, Wattanachayakul Phuuwadith, Malin John, Leguizamon Raul, John Tara A, Vera Ricaurte Michael, Jarrett Simone A, Lo Kevin Bryan, Witzke Christian
Аннотация
BACKGROUND: Pulmonary hypertension (PH) is common among chronic kidney disease (CKD) patients. Early detection of postcapillary PH may help identify CKD patients at risk of adverse cardiovascular outcomes.
OBJECTIVES: To assess the clinical outcomes among patients with borderline pulmonary artery wedge pressure (PAWP) (12-15 mmHg).
METHODS: This was a single-center retrospective cohort study of patients with CKD stages 3b, 4, and 5 who underwent right heart catheterization between 2018 and 2023. We excluded patients receiving dialysis. We stratified the data into 4 groups: group 1 (non-PH) and groups 2-4 (PAWP groups); group 2 (low PAWP [<12 mmHg]), group 3 (borderline PAWP [12-15 mmHg]), and group 4 (high PAWP [>15 mmHg]). We performed a multivariable analysis to determine if borderline PAWP was independently associated with 1-year major cardiovascular events (MACE).
RESULTS: Of 406 CKD patients, 15 % (n = 59) had non-PH, 14 % (n = 55) had low PAWP, 14 % (n = 55) had borderline PAWP, and 58 % (n = 237) had elevated PAWP. The incidence of 1-year MACE in the non-PH group was 17 %, low PAWP group (31 %), borderline PAWP group (40 %), and high PAWP group (30 %). Among the borderline PAWP group, MACE were primarily driven by non-fatal heart failure exacerbations. Compared to the non-PH group, the borderline PAWP group had a greater risk of developing 1-year MACE (adjusted hazard ratio = 2.38, [95 % confidence interval 1.02-5.55], p = 0.044).
CONCLUSIONS: Borderline PAWP (12-15mmHg) is independently associated with MACE in PH-CKD patients. Early detection of postcapillary PH in CKD patients should prompt optimization of CV risk factors to potentially improve clinical outcomes.
OBJECTIVES: To assess the clinical outcomes among patients with borderline pulmonary artery wedge pressure (PAWP) (12-15 mmHg).
METHODS: This was a single-center retrospective cohort study of patients with CKD stages 3b, 4, and 5 who underwent right heart catheterization between 2018 and 2023. We excluded patients receiving dialysis. We stratified the data into 4 groups: group 1 (non-PH) and groups 2-4 (PAWP groups); group 2 (low PAWP [<12 mmHg]), group 3 (borderline PAWP [12-15 mmHg]), and group 4 (high PAWP [>15 mmHg]). We performed a multivariable analysis to determine if borderline PAWP was independently associated with 1-year major cardiovascular events (MACE).
RESULTS: Of 406 CKD patients, 15 % (n = 59) had non-PH, 14 % (n = 55) had low PAWP, 14 % (n = 55) had borderline PAWP, and 58 % (n = 237) had elevated PAWP. The incidence of 1-year MACE in the non-PH group was 17 %, low PAWP group (31 %), borderline PAWP group (40 %), and high PAWP group (30 %). Among the borderline PAWP group, MACE were primarily driven by non-fatal heart failure exacerbations. Compared to the non-PH group, the borderline PAWP group had a greater risk of developing 1-year MACE (adjusted hazard ratio = 2.38, [95 % confidence interval 1.02-5.55], p = 0.044).
CONCLUSIONS: Borderline PAWP (12-15mmHg) is independently associated with MACE in PH-CKD patients. Early detection of postcapillary PH in CKD patients should prompt optimization of CV risk factors to potentially improve clinical outcomes.