Echocardiographic Predictors of Mortality in Cardiac Intensive Care Unit Patients With Pulmonary Hypertension

Pulmonary Hypertension (PH) is associated with high mortality in Cardiac Intensive Care Unit (CICU) patients. We sought to determine the association of Transthoracic Echocardiography (TTE) parameters with in-hospital mortality in patients admitted to the CICU, and found to have PH. We included Mayo Clinic CICU admissions from 2007 to 2018, with a TTE within 1 day of CICU admission demonstrating PH, defined as estimated right ventricular systolic pressure (RVSP) ≥36 mmHg. Logistic regression was used to identify predictors of in-hospital mortality. We included 3085 unique CICU patients with PH by TTE; median age was 73.7 (63.8, 82.4) years, and 1343 (43.5%) were females. Heart failure (65.6%) and respiratory failure (34.0%) were the most common admission diagnoses. The median RVSP was 47 (41, 56) mmHg, and 1314 (42.6%) had RVSP ≥50 mmHg. A total of 337 (10.9%) patients died during hospitalization. The RVSP was higher among in-hospital deaths (51 vs 47 mmHg, p < 0.001), reflecting higher right atrial (RA) pressure (14 versus 10 mmHg, p < 0.001). In-hospital mortality increased with higher RA pressure and worse Right Ventricle-Pulmonary Artery (RV-PA) coupling, such as a lower tricuspid S' velocity to RVSP ratio (AUC 0.72) or higher pulmonary artery elastance (AUC 0.72). In conclusion, in CICU patients found to have elevated pulmonary pressures, several 2D and Doppler TTE parameters predict in-hospital mortality. Specifically, RA pressure and parameters of RV-PA coupling, had highest association with worse outcomes. Early identification of high-risk hemodynamic parameters may facilitate improved investigation, management, and prognostication.