Mild pulmonary hypertension and premature mortality among 154956 men and women undergoing routine echocardiography

Abstract

Background Although mild pulmonary hypertension is known to be associated with increased mortality, its impact on premature mortality is largely unknown. Methods We studied the distribution of estimated right ventricular systolic pressure (eRVSP) among a total of 154956 adults with no evidence of left heart disease investigated with echocardiography. We then examined individually linked mortality, premature mortality and associated life-years lost (LYL) according to eRVSP levels. Results The cohort comprised 70826 men and 84130 women (aged 61.3±17.7 and 61.4±18.4 years, respectively). Overall, 85173 (55.0%), 49276 (31.8%), 13060 (8.4%) and 7447 (4.8%) cases had eRVSP levels indicative of no (<30.0 mmHg), mild (30.0-39.9 mmHg), moderate (40.0-49.9 mmHg) or severe (≥50.0 mmHg) pulmonary hypertension, respectively. During a median (interquartile range) 5.7 (3.2-8.9) years of follow-up, 38456/154986 (24.8%) individuals died. Compared with eRVSP <30.0 mmHg, age and sex-adjusted hazard ratios for all-cause and cardiovascular-related mortality were 1.90 (95% CI 1.84-1.96) and 1.85 (95% CI 1.74-1.97), respectively, for eRVSP 35.0-39.9 mmHg. Overall, 6256 (54%) men and 7524 (55%) women died prematurely. As a proportion of all deaths, premature mortality rose from 46.7% to 79.2% among those with eRVSP <30.0 versus ≥60.0 mmHg with a mean of 5.1-11.4 LYL each time. However, due to more individuals affected overall, eRVSP 30.0-39.9 mmHg accounted for 58% and 53% of total LYL among men (40606/70019 LYL) and women (47333/88568 LYL), respectively. Conclusions These data confirm that elevated eRVSP levels indicative of mild pulmonary hypertension are associated with increased risk of death. Moreover, this results in a substantive component of premature mortality/LYL that requires more proactive clinical surveillance and management.