Prevalence and Clinical Characteristics Associated with Pulmonary Hypertension in African-Americans

<div><p>Background</p><p>Pulmonary hypertension (PH) is associated with increased mortality and morbidity. It is frequently associated with cardiopulmonary diseases that are prevalent in African Americans (AAs). However, the prevalence or determinants of PH in the AA population is not known. </p> <p>Methods</p><p>We conducted a cross-sectional study to estimate the prevalence of PH (defined as trans-tricuspid gradient ≥ 35 mm Hg) and associated clinical characteristics in AAs using the Jackson Heart Study cohort (n=3,282) who underwent echocardiography and had a measurable trans-tricuspid regurgitant jet. Echocardiography is frequently used for screening for PH despite its limitations in estimating accurate PA systolic pressures. Overall and age-adjusted gender-specific prevalence were estimated and modified Poisson regression was used to identify independent clinical, spirometric, and echocardiographic characteristics associated with PH.</p> <p>Results</p><p>The mean age of the study population was 56.1 ± 12.6 years with 67.5% female. The prevalence of PH was 6.8%, with higher prevalence in female AAs (age-adjusted prevalence: Men 4.9%, 95% CI 3.6-6.2%; Women 7.7%, 95% CI 6.6-8.8%). Pulmonary hypertension prevalence increased with age (Prevalence Ratio: 10.0, 95%CI 4.0-25.1, >65 versus <45 years old), presence of obesity, higher pulse pressure, diabetes, obstructive or restrictive spirometry pattern, and severe left heart valvular disease. Also, PH was significantly associated with left atrial size and left ventricular ejection fraction.</p> <p>Conclusions</p><p>Pulmonary hypertension is prevalent in AAs, more in women than in men. The identified cardiopulmonary risk factors that increase the prevalence of PH may assist in diagnosis and management of these at-risk subjects in the AA population.</p> </div

Distribution of trans-tricuspid gradients in study cohort.

<p>Vertical line indicates a gradient of 35 mm of Hg that was used as a cut-off for definition of pulmonary hypertension.</p

Prevalence of pulmonary hypertension based on age groups and gender.

<p>Prevalence of pulmonary hypertension based on age groups and gender.</p

Relationship of Iron Deficiency and Serum Ferritin Levels with Pulmonary Hypertension: The Jackson Heart Study

<div><p>Purpose</p><p>Iron deficiency is prevalent in idiopathic pulmonary arterial hypertension (IPAH), but whether iron deficiency or ferritin levels are associated with pulmonary hypertension (PH) in the general population is unknown.</p><p>Methods</p><p>We performed a cross-sectional analysis of data on iron deficiency (exposure), and PH (pulmonary artery systolic pressure>40mmHg on echocardiogram) (outcome) on subjects with complete data on exposures and outcomes as well as covariates (n = 2,800) enrolled in the Jackson Heart Study, a longitudinal prospective observational cohort study of heart disease in African-Americans from Jackson, Mississippi. Iron deficiency was defined as a serum ferritin level < 15ng/mL (females); < 30ng/mL (males). We determined crude prevalence ratios (PRs) for PH in iron deficient versus non-iron deficient groups using modified Poisson regression modeling. We also analyzed the prevalence of PH by sex-specific quartiles of ferritin (Females ≤ 47ng/mL; > 47ng/mL– 95ng/mL; > 95ng/mL– 171ng/mL; > 171ng/mL; Males ≤ 110ng/mL; > 110ng/mL– 182ng/mL; > 182ng/mL– 294ng/mL; > 294ng/mL), using the same modeling technique with the lowest quartile as the referent.</p><p>Results</p><p>Median pulmonary artery systolic pressure was 27mmHg (interquartile range 23-31mmHg) in the study cohort. 147 subjects (5.2%) had PH and 140 (5.0%) had iron deficiency. However, of the 147 subjects with PH, only 4 were also iron deficient. The crude PH PR was 0.5 (95% CI 0.2–1.4) in iron-deficiency compared to non-deficient. In analysis by quartiles of ferritin, adjusting for age and sex, there was no evidence of association with PH in quartiles 2 (PR 1.1, 95% CI 0.7–1.6), 3 (PR 0.8, 95% CI 0.5–1.3), or 4 (PR 0.8, 95% CI 0.5–1.2) compared with quartile 1 (referent group, PR 1). Further analyses of the relationship between PH and ferritin as a log-transformed continuous variable or by quartiles of serum iron showed similar results.</p><p>Conclusions</p><p>In the Jackson Heart Study, the prevalence of PH was similar in iron-deficient and non-iron deficient subjects. There was no evidence of association between ferritin (or serum iron) levels and PH.</p><p>Clinical Implications</p><p>Iron deficiency has been associated with IPAH, a rare disorder. However, in a large community-based sample of African-Americans, there was no evidence that iron deficiency or low iron levels were associated with PH.</p></div

Association of Ferritin and Iron with Pulmonary Hypertension in the JHS analysis sample, n = 2,800.

<p>Association of Ferritin and Iron with Pulmonary Hypertension in the JHS analysis sample, n = 2,800.</p

Baseline demographics of the analysis sample and stratified by quartiles of ferritin.

<p>Baseline demographics of the analysis sample and stratified by quartiles of ferritin.</p

Venn diagram of pulmonary hypertension (n = 147) and iron deficiency based on low ferritin levels (n = 140) in the Jackson Heart Study cohort.

<p>Only 4 participants had both iron deficiency and pulmonary hypertension.</p

Details of analysis sample derivation.

<p>Details of analysis sample derivation.</p

Additional file 6: of Residential distance to major roadways and cardiac structure in African Americans: cross-sectional results from the Jackson Heart Study

Figure A3. Association between LV end-systolic diameter and natural log of residential distance to A1 or A2 roads among participants in the Jackson Heart Study, fitted using a natural spline with 3° of freedom for distance to A1 or A2, adjusting for covariates. Shaded area represents 95% confidence interval. (N = 4826).a. aAdjusted for age, sex, body mass index, alcohol consumption, education level, occupation, neighborhood socioeconomic status z-score, type of medical insurance, and smoking status. (TIFF 1392 kb

Echocardiographic Predictors of Mortality in Patients with Pulmonary Hypertension and Cardiopulmonary Comorbidities

<div><p>Objective</p><p>We aimed to identify the echocardiographic measures associated with survival in a patient population with a high prevalence of co-morbid cardiovascular and pulmonary disease that have significantly elevated estimated pulmonary artery systolic pressures (ePASP).</p><p>Background</p><p>Pulmonary hypertension (PH) is a clinical feature of several cardiopulmonary diseases that are prevalent among elderly. While certain echocardiographic parameters have been shown to be important in the prognosis in specific PH groups, the prognostic relevance of echocardiographic characteristics in a cohort with multiple cardiopulmonary comorbidities is unclear.</p><p>Methods</p><p>We retrospectively identified 152 patients with ePASP > 60 mmHg by echocardiography over a five year period (6/2006–11/2011) and followed until 4/2013. Candidate clinical and echocardiographic characteristics suggestive of PH severity were compared between deceased and surviving subpopulations. Cox proportional hazard modeling was used to identify echocardiographic predictors of death adjusted for age and clinical characteristics.</p><p>Results</p><p>This was a predominantly elderly (age 78.8 ± 10.2 years), male (98.7%) cohort with several cardiopulmonary comorbidities. Overall mortality was high (69.7%, median survival 129 days). After adjusting for age and clinical characteristics, decreased right ventricular (RV) systolic function assessed by tricuspid annular plane systolic excursion (HR 0.56, 95% CI 0.33–0.96, p = 0.034) and increased RV thickness (HR: 4.34, 95% CI: 1.49–12.59, p = 0.007) were independently associated with mortality. In contrast, left ventricular systolic function, left ventricular diastolic parameters, ePASP, or echo-derived pulmonary vascular resistance (PVR) were not associated with increased mortality.</p><p>Conclusion</p><p>In a cohort of patients with PH and high prevalence of cardio-pulmonary comorbidities, RV systolic function and hypertrophy are associated with mortality and may be the most relevant echocardiographic markers for prognosis.</p></div