Pulmonary vascular dysfunction among people aged over 65 years in the community in the Atherosclerosis Risk In Communities (ARIC) Study: A cross-sectional analysis

Autoři: Kanako Teramoto aff001;  Mário Santos aff001;  Brian Claggett aff001;  Jenine E. John aff001;  Scott D. Solomon aff001;  Dalane Kitzman aff005;  Aaron R. Folsom aff006;  Mary Cushman aff007;  Kunihiro Matsushita aff009;  Hicham Skali aff001;  Amil M. Shah aff001
Působiště autorů: Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America aff001;  Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan aff002;  Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine, University of Porto, Portugal aff003;  Department of Cardiology, Hospital Santo António, Porto Hospital Center, Porto, Portugal aff004;  Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America aff005;  Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America aff006;  Department of Medicine, University of Vermont, Burlington, Vermont, United States of America aff007;  Department of Pathology, University of Vermont, Burlington, Vermont, United States of America aff008;  Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America aff009
Vyšlo v časopise: Pulmonary vascular dysfunction among people aged over 65 years in the community in the Atherosclerosis Risk In Communities (ARIC) Study: A cross-sectional analysis. PLoS Med 17(10): e32767. doi:10.1371/journal.pmed.1003361
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003361



Heart failure (HF) risk is highest in late life, and impaired pulmonary vascular function is a risk factor for HF development. However, data regarding the contributors to and prognostic importance of pulmonary vascular dysfunction among HF-free elders in the community are limited and largely restricted to pulmonary hypertension. Our objective was to define the prevalence and correlates of abnormal pulmonary pressure, resistance, and compliance and their association with incident HF and HF phenotype (left ventricular [LV] ejection fraction [LVEF] ≥ or < 50%) independent of LV structure and function.

Methods and findings

We performed cross-sectional and time-to-event analyses in a prospective epidemiologic cohort study, the Atherosclerosis Risk in Communities study. This is an ongoing, observational study that recruited 15,792 persons aged 45–64 years between 1987 and 1989 (visit 1) from four representative communities in the United States: Minneapolis, Minnesota; Jackson, Mississippi; Hagerstown, Maryland; and Forsyth County, North Carolina. The current analysis included 2,810 individuals aged 66–90 years, free of HF, who underwent echocardiography at the fifth study visit (June 8, 2011, to August 28, 2013) and had measurable tricuspid regurgitation by spectral Doppler. Echocardiography-derived pulmonary artery systolic pressure (PASP), pulmonary vascular resistance (PVR), and pulmonary arterial compliance (PAC) were measured. The main outcome was incident HF after visit 5, and key secondary end points were incident HF with preserved LVEF (HFpEF) and incident HF with reduced LVEF (HFrEF). The mean ± SD age was 76 ± 5 years, 66% were female, and 21% were black. Mean values of PASP, PVR, and PAC were 28 ± 5 mm Hg, 1.7 ± 0.4 Wood unit, and 3.4 ± 1.0 mL/mm Hg, respectively, and were abnormal in 18%, 12%, and 14%, respectively, using limits defined from the 10th and 90th percentile limits in 253 low-risk participants free of cardiovascular disease or risk factors. Left heart dysfunction was associated with abnormal PASP and PAC, whereas a restrictive ventilatory deficit was associated with abnormalities of PASP, PVR, and PAC. PASP, PVR, and PAC were each predictive of incident HF or death (hazard ratio per SD 1.3 [95% CI 1.1–1.4], p < 0.001; 1.1 [1.0–1.2], p = 0.04; 1.2 [1.1–1.4], p = 0.001, respectively) independent of LV measures. Elevated pulmonary pressure was predictive of incident HFpEF (HFpEF: 2.4 [1.4–4.0, p = 0.001]) but not HFrEF (1.4 [0.8–2.5, p = 0.31]). Abnormal PAC predicted HFrEF (HFpEF: 2.0 [1.0–4.0, p = 0.05], HFrEF: 2.8 [1.4–5.5, p = 0.003]), whereas abnormal PVR was not predictive of either (HFpEF: 0.9 [0.4–2.0, p = 0.85], HFrEF: 0.7 [0.3–1.4, p = 0.30],). A greater number of abnormal pulmonary vascular measures was associated with greater risk of incident HF. Major limitations include the use of echo Doppler to estimate pulmonary hemodynamic measures, which may lead to misclassification; inclusions bias related to detectable tricuspid regurgitation, which may limit generalizability of our findings; and survivor bias related to the cohort age, which may result in underestimation of the described associations.


In this study, we observed abnormalities of PASP, PVR, and PAC in 12%–18% of elders in the community. Higher PASP and lower PAC were independently predictive of incident HF. Abnormally high PASP predicted incident HFpEF but not HFrEF. These findings suggest that impairments in pulmonary vascular function may precede clinical HF and that a comprehensive pulmonary hemodynamic evaluation may identify pulmonary vascular phenotypes that differentially predict HF phenotypes.

Klíčová slova:

Cardiovascular disease risk – Ejection fraction – Heart – Heart failure – Hemodynamics – Pulmonary arteries – Systolic pressure – Venous thromboembolism


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