Peculiarities of the evolution of pulmonary hypertension in patients with ischemic heart failure 12 months after myocardial revascularization
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.02Keywords:
pulmonary hypertension, echocardiographic probability of pulmonary hypertension, myocardial revascularization, ischemic heart failureAbstract
Pulmonary hypertension (PH) associated with left heart disease is common and has an important impact on disease progression, morbidity and mortality. We aimed to identify the particularities of PH evolution in patients with ischemic heart failure during 12 months after myocardial revascularization (MRev) by coronary artery bypass grafting or percutaneous coronary angioplasty.Methods: The research included 281 patients undergoing MRev (mean age=63.2±9.7 years, 76.5%- men). Follow up period - 12.6±1.6 months. The patients were divided according to the echocardiographic probability of PH (PHPr) into 3 groups: low PHPr (117 patients), intermediate PHPr (74 patients), high PHPr (90 patients). Results. The prevalence of PH 12 months after MRev constituted 69.7%, increasing by 10% compared to the initial period. We highlighted a negative evolution of PHPr during 1 year after MRev: 42.8% of patients with initially low PHPr and 54.1% of those with intermediate PHPr had a higher degree of PHPr. The peak tricuspid regurgitation velocity and the pulmonary artery systolic pressure did not change significantly during 12 months after the acute event. The negative evolution of PHPr was determined by the negative dynamics of additional echocardiographic signs suggestive for PH: the right atrium area (+2,2±0.4mm), the right ventricular outflow tract acceleration time (-7.6±1.2ms), the inferior vena cava diameter (+0.55±0.2mm). During 12 months after MRev, 5 patients died, all of them had high PHPr (p<0.01), and the hospitalization rate was significantly higher in this group (high PHPr - 57.1%, intermediate PHPr - 43.2%, low PHPr - 38.7%, p<0.05). Conclusions: The PH prevalence 12 months after MRev was 69.7%, increasing by 10% compared to the initial period. A negative evolution of PHPr was noted during 1 year follow up. Patients with high and intermediate PHPr had a higher rate of hospitalizations during the 12 months after MRev and all deceased patients had high PHPr.
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