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Changes in Pulmonary Artery Pressure Late in Life
Quick Takes
- No difference in longitudinal pulmonary artery systolic pressure (PASP) was noted by sex or race. However, PASP increased more in older participants.
- Increases in PASP were associated with concomitant increases in measures of LV filling pressure, including E/e’ ratio and left atrial volume index.
- Each 5 mm Hg increase was associated with 16% higher odds of developing dyspnea (odds ratio, 1.16; 95% confidence interval, 1.07-1.27; p < 0.001).
Study Questions:
Is longitudinal change in pulmonary pressure associated with cardiac or pulmonary dysfunction?
Methods:
Data from the ARIC (Atherosclerosis Risk in Communities) study were used for this study. Among participants with echocardiographic measures of pulmonary artery systolic pressure (PASP) taken at both the fifth (2011–2013) and seventh (2018–2019) visits, longitudinal changes in PASP were examined. Tricuspid regurgitation (TR) spectral Doppler was assessed in the apical four-chamber view, and in the parasternal right ventricular inflow view at visit 7. Peak TR velocity was measured as the peak velocity of TR spectral Doppler profile and was averaged over three consecutive beats of adequate quality. PASP was calculated using the peak TR velocity (m/s) and assuming a right atrial pressure of 5 mm Hg using the simplified Bernoulli equation. The primary outcome of interest was development of cardiac and pulmonary dysfunction associated with changes in PASP, and development of dyspnea.
Results:
A total of 1,420 participants from the ARIC study were included in the present analysis. Mean age was 75 ± 5 years at visit 5 and 81 ± 5 years at visit 7, 24% were Black adults, and 68% were female. Over the 6.5 years, PASP increased by 5 ± 8 mm Hg from 28 ± 5 to 33 ± 8 mm Hg. The prevalence of PASP >32 mm Hg increased from 14% to 31%, while prevalence of PASP >40 mm Hg increased from 2% to 16%. Similar changes in PASP were observed among men and women (5 ± 8 and 5 ± 8 mm Hg, respectively; p = 0.58) and among Black and White participants (6 ± 8 and 5 ± 8 mm Hg, respectively; p = 0.91). PASP increased more in older participants. Predictors of greater increase in PASP included worse left ventricular (LV) systolic and diastolic function, pulmonary function, and renal function. Increases in PASP were associated with concomitant increases in measures of LV filling pressure, including E/e’ ratio and left atrial volume index. Each 5 mm Hg increase was associated with 16% higher odds of developing dyspnea (odds ratio, 1.16; 95% confidence interval, 1.07-1.27; p < 0.001).
Conclusions:
The authors conclude that pulmonary pressure increases over 6.5 years in late life are associated with concomitant increases in LV filling pressure and predict the development of dyspnea. Interventions targeting LV diastolic function may be effective at mitigating age-related increases in PASP.
Perspective:
Primary prevention, including management to reduce LV dysfunction, is likely effective in reducing increases in PASP over time.
Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention
Keywords: Dyspnea, Geriatrics, Pulmonary Artery
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