{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:00:33Z","timestamp":1792000833661,"version":"4.4.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,3,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Pulmonary arterial hypertension (\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              ) is a lethal disease. In resource\u2010limited countries\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              outcomes are worse because therapy costs are prohibitive. To improve global outcomes, noninvasive and widely available biomarkers that identify high\u2010risk patients should be defined. Serum chloride is widely available and predicts mortality in left heart failure, but its prognostic utility in\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              requires further investigation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In this study 475 consecutive\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              patients evaluated at the University of Minnesota and Vanderbilt University\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              clinics were examined. Clinical characteristics were compared by tertiles of serum chloride. Both the Kaplan\u2010Meier method and Cox regression analysis were used to assess survival and predictors of mortality, respectively. Categorical net reclassification improvement and relative integrated discrimination improvement compared prediction models.\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              patients in the lowest serum chloride tertile (\u2264101\u00a0mmol\/L: hypochloremia) had the lowest 6\u2010minute walk distance and highest right atrial pressure despite exhibiting no differences in pulmonary vascular disease severity. The 1\u2010, 3\u2010, and 5\u2010year survival was reduced in hypochloremic patients when compared with the middle\u2010 and highest\u2010tertile patients (86%\/64%\/44%, 95%\/78%\/59%, and, 91%\/79%\/66%). After adjustment for age, sex, diuretic use, serum sodium, bicarbonate, and creatinine, the hypochloremic patients had increased mortality when compared with the middle\u2010tertile and highest\u2010tertile patients. The Minnesota noninvasive model (functional class, 6\u2010minute walk distance, and hypochloremia) was as effective as the French noninvasive model (functional class, 6\u2010minute walk distance, and elevated brain natriuretic peptide or N\u2010terminal pro\u2013brain natriuretic peptide) for predicting mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Hypochloremia (\u2264101\u00a0mmol\/L) identifies high\u2010risk\n              <jats:styled-content style=\"fixed-case\">PAH<\/jats:styled-content>\n              patients independent of serum sodium, renal function, and diuretic use.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015221","type":"journal-article","created":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T10:00:23Z","timestamp":1582279223000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Hypochloremia Is a Noninvasive Predictor of Mortality in Pulmonary Arterial Hypertension"],"prefix":"10.1161","volume":"9","author":[{"given":"Kurt W.","family":"Prins","sequence":"first","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajat","family":"Kalra","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Rose","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tufik R.","family":"Assad","sequence":"additional","affiliation":[{"name":"Williamson County Medical Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen L.","family":"Archer","sequence":"additional","affiliation":[{"name":"Queen's University Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navkaranbir S.","family":"Bajaj","sequence":"additional","affiliation":[{"name":"University of Alabama\u2010Birmingham Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Kenneth","family":"Weir","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha Z.","family":"Prisco","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Pritzker","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela L.","family":"Lutsey","sequence":"additional","affiliation":[{"name":"School of Public Health University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan L.","family":"Brittain","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center and Vanderbilt Translational and Clinical Cardiovascular Research Center Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thenappan","family":"Thenappan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j5492"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2016.04.001"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2014.08.007"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01889-2018"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200712-1876OC"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.06.007"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002453"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1247"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.04.022"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1086\/688879"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201809-594OC"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.09.942"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01913-2018"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.008461"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.09.054"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00889-2017"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4085"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu065"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2007.07.011"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2017.01.007"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1126\/scisignal.2005050"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M113.451575"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2336103100"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M110.159418"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/2211-5463.12528"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00109-011-0804-9"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00109-009-0524-6"},{"key":"e_1_3_1_30_2","first-page":"BR261","article-title":"Upregulation of GLUT\u20104 in right ventricle of rats with monocrotaline\u2010induced pulmonary hypertension","volume":"14","author":"Broderick TL","year":"2008","unstructured":"Broderick TL, King TM. 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