https://orcid.org/0000-0003-2572-8340
Key Points
High pulmonary hypertension risk in Polycythemia Vera results in worse overall survival and warrants screening in selected patients.
Common pro-inflammatory pathways between Polycythemia Vera and Myelofibrosis may drive development pulmonary hypertension in these patients.
Pulmonary Hypertension (PH) is a known complication of myeloproliferative neoplasms (MPN) with estimated prevalence as high as 50%. Patients with Polycythemia Vera (PV) report a wide spectrum of symptoms that significantly overlap with those reported by patients with PH. Yet, it is not known how PH affects outcomes and survival in patients with PV. To address this gap, we investigated the impact of echocardiogram (ECHO) PH risk on survival of patients with PV from our large single center cohort. Of 637 patients with PV, 134 had at least one ECHO and were included for analysis. Overall survival (OS) did not differ between patients who had or did not have ECHO. PH risk was established based on tricuspid regurgitation jet velocity. Kaplan-Meier analysis showed that high PH risk is associated with shortened survival compared to mild PH risk (median survival 1.7 vs 3.7 years) or normal PH risk (median survival not yet reached). Cox Proportional Hazard Models found high PH risk was associated with >3-fold increased risk of death, independent of age and thrombosis history. Logistic regression identified age (odds ratio 6.9) and duration of PV diagnosis (odds ratio 5.4) as significant risks for PH. Based upon these results and receiver operator characteristic optimization, we recommend echocardiographic screening for patients with PV older than 70 years or with duration of PV longer than 8 years. Further studies inclusive of invasive hemodynamics, advanced CV imaging, and MPN-associated biomarkers are needed to best characterize this Group 5 PH patient population for therapeutic interventions.
