Elevated Pulmonary Artery Systolic Pressure Predicts Heart Failure Admissions in African Americans: Jackson Heart Study
Background—While elevated pulmonary artery systolic pressure (PASP) is associated with heart failure (HF), whether PASP measurement can help predict future HF admissions is not known, especially in African-Americans, who are at increased risk for HF. We hypothesized that elevated PASP is associated with increased risk of HF admission and improves HF prediction in African-American (AA) population.
Methods and Results—We conducted a longitudinal analysis using the JHS cohort (n=3125, 32.2% men) with baseline echo-derived PASP and follow-up for HF admissions. Hazard ratio for HF admission was estimated using Cox-proportional hazard model adjusted for variables in the Atherosclerosis Risk in Community (ARIC) HF prediction model. Over median follow up of 3.46 years, 3.42% of the cohort was admitted for HF. Subjects with HF had a higher PASP (35.6 ± 11.4 mm Hg vs. 27.6 ± 6.9 mm Hg, p<0.001). The hazard of HF admission increased with higher baseline PASP (adjusted HR/10 mmHg increase in PASP: 2.03, 95% CI: 1.67-2.48; adjusted HR for highest (≥33 mmHg) versus lowest quartile (<24 mmHg) of PASP: 2.69, 95% CI: 1.43-5.06) and remained significant irrespective of history of HF, or preserved/reduced ejection fraction. Addition of PASP to the ARIC model resulted in a significant improvement in model discrimination (AUC = 0.82 before vs. 0.84 after, p = 0.03), and improved net reclassification index (11-15%), using PASP as a continuous or dichotomous (cutoff: 33 mm Hg) variable.
Conclusions—Elevated PASP predict HF admissions in African Americans and may aid in early identification of at risk subjects for aggressive risk factor modification.
- Received April 7, 2014.
- Accepted June 4, 2014.