ArticleCirculation2016
Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.
3 registry-linked trialsOpen access · bronzeAbstract read
In one paragraph
Article in Circulation, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 206 papers, 5 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
206citing papers in PubMed, 5 pooled it
26.6field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effects of a Home Telerehabilitation Program Via Videoconference in Patients With Pulmonary Arterial Hypertension- Randomized Clinical Trial
Deep Learning for Detection of Pulmonary Hypertension and Reduced Left Ventricular Ejection Fraction Using a Combined Digital Stethoscope and Three-lead Electrocardiogram
Deep Learning for Algorithmic Detection of Pulmonary Hypertension Using a Combined Digital Stethoscope and Three-lead Electrocardiogram
Who cites it
206 citing papers in PubMed, 5 syntheses or guidelines pooled it, 393 citations in OpenAlex.
- Implanted haemodynamic telemonitoring devices to guide management of heart failure: a review and meta-analysis of randomised trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2023Pooled it
- Prevalence, Risk Factors and Intervention for Depression and Anxiety in Pulmonary Hypertension: A Systematic Review and Meta-analysis.Frontiers in medicine · 2022Pooled it
- The prognostic significance of the alterations of pulmonary hemodynamics in patients with pulmonary arterial hypertension: a meta-regression analysis of randomized controlled trials.Systematic reviews · 2021Pooled it
- Mildly Elevated Pulmonary Arterial Pressure Is Associated With a High Risk of Progression to Pulmonary Hypertension and Increased Mortality: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2021Pooled it
- Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2018Pooled it
- Article
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- Invasive Cardiopulmonary Exercise Testing Identifies Distinctive Hemodynamic Phenotypes in Patients with Interstitial Lung Disease and Exercise Intolerance.Respiration; international review of thoracic diseases · 2026Article
- Pulmonary Hypertension Redefined: From Historical Thresholds to Prognostic Relevance.Korean circulation journal · 2025Article
- Impact of the New Definition on the Prognosis of Patients With Pulmonary Hypertension Compared to the Classic Definition.Korean circulation journal · 2025Article
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- Clinical research on echocardiographic screening for pulmonary hypertension: TRV >2.8 m/s and mPAP >20 mmHg.Quantitative imaging in medicine and surgery · 2025Article
146 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
20 authors at 1 institution in 1 country.
Bradley A MaronFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.). Bradley.Maron@va.gov.
Edward HessFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Thomas M MaddoxFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Alexander R OpotowskyFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Ryan J TedfordFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Tim LahmFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Karen E JoyntFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Daniel J KassFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Thomas StephensFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Maggie A StanislawskiFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Erik R SwensonFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Ronald H GoldsteinFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Jane A LeopoldFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Roham T ZamanianFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Jean M ElwingFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Mary E PlomondonFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Gary K GrunwaldFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Anna E BarónFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
John S RumsfeldFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Gaurav ChoudharyFrom Veterans Affairs Boston Healthcare System, MA (B.A.M., R.H.G.); Brigham and Women's Hospital and Harvard Medical School, Boston, MA (B.A.M., A.R.O., T.S., J.A.L.); Veterans Affairs Eastern Colorado Health Care System, Denver (E.H., T.M.M., M.A.S., M.E.P., G.K.G., A.E.B., J.R.); University of Colorado School of Medicine (T.M.M.); Boston Children's Hospital, MA (A.R.O.); Department of Medicine, Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD (R.J.T.); Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (T.L.); Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC (K.E.J.); Veterans Affairs Pittsburgh Healthcare System, PA (D.J.K.); VA Puget Sound Health Care System and University of Washington, Seattle (E.R.S.); Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford University School of Medicine, CA (R.T.Z.); Cincinnati Veterans Affairs Medical Center and University of Cincinnati, OH (J.M.E.); and Providence Veterans Affairs Medical Center and Alpert Medical School of Brown University, Providence, RI (G.C.).
Johns Hopkins University · US
Funding
The Cellular Response to Elafin in PAHP01HL108797 · NHLBI · STANFORD UNIVERSITY · PI RABINOVITCH, MARLENE · 2011 to 2021
$19.7MPulmonary Hypertension Breakthrough InitiativeR24HL123767 · NHLBI · UNIVERSITY OF COLORADO DENVER · PI ALDRED, MICHEALA A, ERZURUM, SERPIL C. · 2014 to 2017
$10.1MiPSC Derived EC as Surrogates Using Pulmonary Hypertension as a Prototype DiseaseU01HL107393 · NHLBI · STANFORD UNIVERSITY · PI RABINOVITCH, MARLENE, SNYDER, MICHAEL P. · 2011 to 2015
$8.7MTargeting FAK-NEDD9 protein-protein interaction to prevent focal adhesion assembly and vascular proliferation in pulmonary arterial hypertensionR01HL139613 · NHLBI · UNIVERSITY OF MARYLAND BALTIMORE · PI Sirano Dhe-Paganon, Bradley Maron · 2018 to 2026
$4.1MIntergrated Endothelial Phenotyping to Redefine Pulmonary HypertensionU01HL125215 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI LEOPOLD, JANE A, WAXMAN, AARON B · 2014 to 2018
$1.7MAldosterone impairs endothelin B-dependent synthesis of nitric oxide to promote pK08HL111207 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI MARON, BRADLEY · 2013 to 2017
$754kHypoxia-mediated protective estrogen receptor signaling in pulmonary hypertensionI01BX002042 · VA · VA EASTERN COLORADO HEALTH CARE SYSTEM · PI Tim Lahm · 2014 to 2026
–Endothelial BKCa Channels and Hypoxic Pulmonary Endothelial DysfunctionI01BX000711 · VA · PROVIDENCE VA MEDICAL CENTER · PI CHOUDHARY, GAURAV · 2011 to 2014
–BLRD VA I01 BX000711BLRD VA I01 BX002042NHLBI NIH HHS 1K08HL11207-01A1NHLBI NIH HHS 1U01HL125215-01NHLBI NIH HHS K08 HL111207NHLBI NIH HHS N01 HV00242NHLBI NIH HHS P01 HL108797NHLBI NIH HHS R01 HL139613NHLBI NIH HHS R24 HL123767NHLBI NIH HHS U01 HL107393NHLBI NIH HHS U01 HL125215NHLBI NIH HHS UO1 HL107393VA CDA 08-021
Abstract
backgroundPulmonary hypertension (PH) is associated with increased morbidity across the cardiopulmonary disease spectrum. Based primarily on expert consensus opinion, PH is defined by a mean pulmonary artery pressure (mPAP) ≥25 mm Hg. Although mPAP levels below this threshold are common among populations at risk for PH, the relevance of mPAP <25 mm Hg to clinical outcome is unknown. METHODS AND
resultsWe analyzed retrospectively all US veterans undergoing right heart catheterization (2007-2012) in the Veterans Affairs healthcare system (n=21,727; 908-day median follow-up). Cox proportional hazards models were used to evaluate the association between mPAP and outcomes of all-cause mortality and hospitalization, adjusted for clinical covariates. When treating mPAP as a continuous variable, the mortality hazard increased beginning at 19 mm Hg (hazard ratio [HR]=1.183; 95% confidence interval [CI], 1.004-1.393) relative to 10 mm Hg. Therefore, patients were stratified into 3 groups: (1) referent (≤18 mm Hg; n=4,207); (2) borderline PH (19-24 mm Hg; n=5,030); and (3) PH (≥25 mm Hg; n=12,490). The adjusted mortality hazard was increased for borderline PH (HR=1.23; 95% CI, 1.12-1.36; P<0.0001) and PH (HR=2.16; 95% CI, 1.96-2.38; P<0.0001) compared with the referent group. The adjusted hazard for hospitalization was also increased in borderline PH (HR=1.07; 95% CI, 1.01-1.12; P=0.0149) and PH (HR=1.15; 95% CI, 1.09-1.22; P<0.0001). The borderline PH cohort remained at increased risk for mortality after excluding the following high-risk subgroups: (1) patients with pulmonary artery wedge pressure >15 mm Hg; (2) pulmonary vascular resistance ≥3.0 Wood units; or (3) inpatient status at the time of right heart catheterization.
conclusionsThese data illustrate a continuum of risk according to mPAP level and that borderline PH is associated with increased mortality and hospitalization. Future investigations are needed to test the generalizability of our findings to other populations and study the effect of treatment on outcome in borderline PH.
Indexed as
VeteransAgedAged, 80 and overCardiac CatheterizationCohort StudiesFemaleHospitalizationHumansHypertension, PulmonaryMaleMiddle AgedMortalityResearch ReportRetrospective StudiesUnited StatesUnited States Department of Veterans Affairsoutcome assessmentpulmonary heart diseasepulmonary hypertension
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