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Pulmonary hypertension ups mortality risk even after repair of cardiac defect

12 May 2020

Pulmonary hypertension (PH) occurs rarely after correction of cardiac defects, but is nevertheless a significant mortality risk factor, a new study reports.

The retrospective study included 825 patients (median age, 23 years) with closed, isolated simple cardiac defects, such as atrial septal defect, ventricular septal defect and persistent atrial ducts. The primary study outcome was the risk of PH. Participants with genetic defects were excluded from the analysis.

Over a median follow-up of 15.9 years from defect closure, 25 participants developed PH, resulting in an incidence rate of 3.0 percent. These patients tended to be older and were more likely to have undergone defect closure later in life.

Age emerged as an important mediating factor. The prevalence of PH was 0.7 percent in participants <20 years of age. This shot up to 8.8 percent and 11.9 percent by the fifth and sixth decades of life, respectively. This was confirmed by logistic regression analysis, which showed that age at follow-up was a significant risk factor (odds ratio per additional year, 1.07, 95 percent confidence interval [CI], 1.02–1.11; p=0.003).

Fourteen patients died over the course of the study and the mortality rate was higher in the PH group (20 percent vs 1 percent). Age- and gender-adjusted Cox analysis verified the impact of PH on death risk (hazard ratio per year, 1.015, 95 percent CI, 1.01–1.072; p=0.003).

“Physicians should be aware of the increased risk of PH and its association with heart failure symptoms and increased mortality in this setting. A low threshold for specialized workup is recommended especially in the elderly to ascertain the diagnosis of PH, which has important prognostic and clinical implications,” researchers said.

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 4 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
6 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.