Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities

Y. Adir, M. Guazzi, A. Offer, P.L. Temporelli, A. Cannito, S. Ghio

Research output: Contribution to journal › Article

9 Citations (Scopus)

Abstract

Objective The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival. Methods We retrospectively reviewed the charts of 168 PH-HFrEF and 86 PH-HFpEF patients. The independent association of PCa and DPG with prognosis was assessed by means of a Cox proportional hazard model. All cause survival was analyzed over an average follow-up period of 50 months. Results PH-HFpEF patients had a significantly higher DPG than PH-HFrEF patients (6.1 ± 7.1 vs 1.8 ± 4.5 mmHg, adjusted P =.025). PCa was similar in PH-HFpEF and PH-HFrEF. PCa was a significant predictor of survival, according to previously described preset cutoffs (2.15 mL/mmHg in HFrEF and 1.1 mL/mmHg in HFpEF) and based on a continuous scale; whereas DPG had no impact on survival in both patients groups. Conclusion Our findings suggest that for similar levels of PAWP, pulmonary circulation may be stiffer in patients with HFpEF-PH than patients with HFrEF-PH, leading to higher DPGs. Nonetheless, PCa rather than DPG emerged as the stronger predictor of survival in both left-sided PH phenotypes. © 2017 Elsevier Inc.
Original languageEnglish
Pages (from-to)120-127
Number of pages8
JournalAmerican Heart Journal
Volume192
DOIs
Publication statusPublished - 2017

Fingerprint

Pulmonary Hypertension
Lung Compliance
Heart Failure
Hemodynamics
Lung
Blood Vessels
Survival
Pulmonary Wedge Pressure
Phenotype
Pulmonary Circulation
Proportional Hazards Models

Keywords

  • adult
  • aged
  • all cause mortality
  • Article
  • atrial fibrillation
  • blood vessel compliance
  • cardiac patient
  • cardiovascular mortality
  • cardiovascular parameters
  • cohort analysis
  • diabetes mellitus
  • diastolic pulmonary gradient
  • female
  • follow up
  • heart catheterization
  • heart failure with preserved ejection fraction
  • heart failure with reduced ejection fraction
  • heart index
  • heart output
  • heart right atrium pressure
  • heart right ventricle function
  • heart stroke volume
  • hemodynamic parameters
  • human
  • ischemic heart disease
  • lung artery pressure
  • lung circulation
  • lung compliance
  • lung hemodynamics
  • lung vascular resistance
  • lung wedge pressure
  • major clinical study
  • male
  • medical record review
  • metabolic syndrome X
  • middle aged
  • New York Heart Association class
  • priority journal
  • prognosis
  • pulmonary artery
  • pulmonary hypertension
  • retrospective study
  • smoking habit
  • survival
  • systemic vascular resistance
  • systolic blood pressure
  • tricuspid annular plane systolic excursion
  • complication
  • diastole
  • echocardiography
  • heart failure
  • hemodynamics
  • Hypertension, Pulmonary
  • pathophysiology
  • physiology
  • time factor
  • vascular resistance
  • Aged
  • Cardiac Catheterization
  • Diastole
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Failure
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Pulmonary Circulation
  • Retrospective Studies
  • Stroke Volume
  • Time Factors
  • Vascular Resistance
  • Ventricular Function, Right

Cite this

Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities. / Adir, Y.; Guazzi, M.; Offer, A.; Temporelli, P.L.; Cannito, A.; Ghio, S.

In: American Heart Journal, Vol. 192, 2017, p. 120-127.

Research output: Contribution to journal › Article

Adir, Y, Guazzi, M, Offer, A, Temporelli, PL, Cannito, A & Ghio, S 2017, 'Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities', American Heart Journal, vol. 192, pp. 120-127. https://doi.org/10.1016/j.ahj.2017.06.006
Adir Y, Guazzi M, Offer A, Temporelli PL, Cannito A, Ghio S. Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities. American Heart Journal. 2017;192:120-127. https://doi.org/10.1016/j.ahj.2017.06.006
Adir, Y. ; Guazzi, M. ; Offer, A. ; Temporelli, P.L. ; Cannito, A. ; Ghio, S. / Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities. In: American Heart Journal. 2017 ; Vol. 192. pp. 120-127.
@article{dd481ec94fc04c6f83a9d8de44384098,
title = "Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities",
abstract = "Objective The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival. Methods We retrospectively reviewed the charts of 168 PH-HFrEF and 86 PH-HFpEF patients. The independent association of PCa and DPG with prognosis was assessed by means of a Cox proportional hazard model. All cause survival was analyzed over an average follow-up period of 50 months. Results PH-HFpEF patients had a significantly higher DPG than PH-HFrEF patients (6.1 ± 7.1 vs 1.8 ± 4.5 mmHg, adjusted P =.025). PCa was similar in PH-HFpEF and PH-HFrEF. PCa was a significant predictor of survival, according to previously described preset cutoffs (2.15 mL/mmHg in HFrEF and 1.1 mL/mmHg in HFpEF) and based on a continuous scale; whereas DPG had no impact on survival in both patients groups. Conclusion Our findings suggest that for similar levels of PAWP, pulmonary circulation may be stiffer in patients with HFpEF-PH than patients with HFrEF-PH, leading to higher DPGs. Nonetheless, PCa rather than DPG emerged as the stronger predictor of survival in both left-sided PH phenotypes. {\circledC} 2017 Elsevier Inc.",
keywords = "adult, aged, all cause mortality, Article, atrial fibrillation, blood vessel compliance, cardiac patient, cardiovascular mortality, cardiovascular parameters, cohort analysis, diabetes mellitus, diastolic pulmonary gradient, female, follow up, heart catheterization, heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, heart index, heart output, heart right atrium pressure, heart right ventricle function, heart stroke volume, hemodynamic parameters, human, ischemic heart disease, lung artery pressure, lung circulation, lung compliance, lung hemodynamics, lung vascular resistance, lung wedge pressure, major clinical study, male, medical record review, metabolic syndrome X, middle aged, New York Heart Association class, priority journal, prognosis, pulmonary artery, pulmonary hypertension, retrospective study, smoking habit, survival, systemic vascular resistance, systolic blood pressure, tricuspid annular plane systolic excursion, complication, diastole, echocardiography, heart failure, hemodynamics, Hypertension, Pulmonary, pathophysiology, physiology, time factor, vascular resistance, Aged, Cardiac Catheterization, Diastole, Echocardiography, Female, Follow-Up Studies, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Prognosis, Pulmonary Circulation, Retrospective Studies, Stroke Volume, Time Factors, Vascular Resistance, Ventricular Function, Right",
author = "Y. Adir and M. Guazzi and A. Offer and P.L. Temporelli and A. Cannito and S. Ghio",
note = "Export Date: 2 March 2018 CODEN: AHJOA Correspondence Address: Adir, Y.; Pulmonary Division, Lady Davis Carmel Medical Center, 7 Michal St., Israel; email: adir-sh@zahav.net.il References: Guazzi, M., Naeije, R., Pulmonary hypertension in heart failure: Pathophysiology, pathobiology, and emerging clinical perspectives (2017) J Am Coll Cardiol, 69, pp. 1718-1734; Hill, N.S., Preston, I., Roberts, K., Defining the phenotypes for pulmonary hypertension associated with diastolic heart failure (2011) Circ Heart Fail, 4, pp. 238-240; Guazzi, M., Borlaug, B.A., Pulmonary hypertension due to left heart disease (2012) Circulation, 126, pp. 975-990; Miller, W.L., Grill, D.E., Borlaug, B.A., Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: Pulmonary hypertension and heart failure (2013) JACC Heart Fail, 1, pp. 290-299; Galie, N., Humbert, M., Vachiery, J.L., 2015 esc/ers guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (esc) and the european respiratory society (ers): Endorsed by: Association for european paediatric and congenital cardiology (aepc), international society for heart and lung transplantation (ishlt) (2015) Eur Respir J, 46, pp. 903-975; Naeije, R., Vachiery, J.L., Yerly, P., The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease (2013) Eur Respir J, 41, pp. 217-223; Vachiery, J.L., Adir, Y., Barbera, J.A., Pulmonary hypertension due to left heart diseases (2013) J Am Coll Cardiol, 62, pp. D100-D108; Assad, T.R., Hemnes, A.R., Larkin, E.K., Clinical and biological insights into combined post- and pre-capillary pulmonary hypertension (2016) J Am Coll Cardiol, 68, pp. 2525-2536; Delgado, J.F., Conde, E., Sanchez, V., Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure (2005) Eur J Heart Fail, 7, pp. 1011-1016; Gerges, C., Gerges, M., Lang, M.B., Diastolic pulmonary vascular pressure gradient: A predictor of prognosis in “out-of-proportion” pulmonary hypertension (2013) Chest, 143, pp. 758-766; Al-Naamani, N., Preston, I.R., Paulus, J.K., Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction (2015) JACC Heart Fail, 3, pp. 467-474; Pellegrini, P., Rossi, A., Pasotti, M., Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure (2014) Chest, 145, pp. 1064-1070; McKee, P.A., Castelli, W.P., McNamara, P.M., The natural history of congestive heart failure: The framingham study (1971) N Engl J Med, 285, pp. 1441-1446; Ponikowski, P., Voors, A.A., Anker, S.D., 2016 esc guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (esc). Developed with the special contribution of the heart failure association (hfa) of the esc (2016) Eur J Heart Fail, 18, pp. 891-975; Nagueh, S.F., Appleton, C.P., Gillebert, T.C., Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009) J Am Soc Echocardiogr, 22, pp. 107-133; Nagy, A.I., Venkateshvaran, A., Merkely, B., Determinants and prognostic implications of the negative diastolic pulmonary pressure gradient in patients with pulmonary hypertension due to left heart disease (2017) Eur J Heart Fail, 19, pp. 88-97; Tedford, R.J., Beaty, C.A., Mathai, S.C., Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension (2014) J Heart Lung Transplant, 33, pp. 289-297; Adir, Y., Humbert, M., Sitbon, O., Out-of-proportion pulmonary hypertension and heart failure with preserved ejection fraction (2013) Respiration, 85, pp. 471-477; Robbins, I.M., Newman, J.H., Johnson, R.F., Association of the metabolic syndrome with pulmonary venous hypertension (2009) Chest, 136, pp. 31-36; Thenappan, T., Shah, S.J., Gomberg-Maitland, M., Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction (2011) Circ Heart Fail, 4, pp. 257-265; Borlaug, B.A., Carter, R.E., Melenovsky, V., Percutaneous pericardial resection: A novel potential treatment for heart failure with preserved ejection fraction (2017) Circ Heart Fail, 10, p. e003612; Amad, K.H., Brennan, J.C., Alexander, J.K., The cardiac pathology of chronic exogenous obesity (1965) Circulation, 32, pp. 740-745; Medoff, B.D., Okamoto, Y., Leyton, P., Adiponectin deficiency increases allergic airway inflammation and pulmonary vascular remodeling (2009) Am J Respir Cell Mol Biol, 41, pp. 397-406; Wong, C.Y., O'Moore-Sullivan, T., Leano, R., Association of subclinical right ventricular dysfunction with obesity (2006) J Am Coll Cardiol, 47, pp. 611-616; Lahm, T., Tuder, R.M., Petrache, I., Progress in solving the sex hormone paradox in pulmonary hypertension (2014) Am J Physiol Lung Cell Mol Physiol, 307, pp. L7-26; Brunner, N.W., Skhiri, M., Fortenko, O., Impact of insulin resistance on ventricular function in pulmonary arterial hypertension (2014) J Heart Lung Transpl, 33, pp. 721-726; Lam, C.S., Borlaug, B.A., Kane, G.C., Age-associated increases in pulmonary artery systolic pressure in the general population (2009) Circulation, 119, pp. 2663-2670; Kawaguchi, M., Hay, I., Fetics, B., Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: Implications for systolic and diastolic reserve limitations (2003) Circulation, 107, pp. 714-720; Paulus, W.J., Tschope, C., A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation (2013) J Am Coll Cardiol, 62, pp. 263-271; Saouti, N., Westerhof, N., Helderman, F., Right ventricular oscillatory power is a constant fraction of total power irrespective of pulmonary artery pressure (2010) Am J Respir Crit Care Med, 182, pp. 1315-1320; Thenappan, T., Prins, K.W., Pritzker, M.R., The critical role of pulmonary arterial compliance in pulmonary hypertension (2016) Ann Am Thorac Soc, 13, pp. 276-284; Tampakakis, E., Leary, P.J., Selby, V.N., The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease (2015) JACC Heart Fail, 3, pp. 9-16; Tedford, R.J., Hassoun, P.M., Mathai, S.C., Pulmonary capillary wedge pressure augments right ventricular pulsatile loading (2012) Circulation, 125, pp. 289-297",
year = "2017",
doi = "10.1016/j.ahj.2017.06.006",
language = "English",
volume = "192",
pages = "120--127",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Pulmonary hemodynamics in heart failure patients with reduced or preserved ejection fraction and pulmonary hypertension: Similarities and disparities

AU - Adir, Y.

AU - Guazzi, M.

AU - Offer, A.

AU - Temporelli, P.L.

AU - Cannito, A.

AU - Ghio, S.

N1 - Export Date: 2 March 2018 CODEN: AHJOA Correspondence Address: Adir, Y.; Pulmonary Division, Lady Davis Carmel Medical Center, 7 Michal St., Israel; email: adir-sh@zahav.net.il References: Guazzi, M., Naeije, R., Pulmonary hypertension in heart failure: Pathophysiology, pathobiology, and emerging clinical perspectives (2017) J Am Coll Cardiol, 69, pp. 1718-1734; Hill, N.S., Preston, I., Roberts, K., Defining the phenotypes for pulmonary hypertension associated with diastolic heart failure (2011) Circ Heart Fail, 4, pp. 238-240; Guazzi, M., Borlaug, B.A., Pulmonary hypertension due to left heart disease (2012) Circulation, 126, pp. 975-990; Miller, W.L., Grill, D.E., Borlaug, B.A., Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: Pulmonary hypertension and heart failure (2013) JACC Heart Fail, 1, pp. 290-299; Galie, N., Humbert, M., Vachiery, J.L., 2015 esc/ers guidelines for the diagnosis and treatment of pulmonary hypertension: The joint task force for the diagnosis and treatment of pulmonary hypertension of the european society of cardiology (esc) and the european respiratory society (ers): Endorsed by: Association for european paediatric and congenital cardiology (aepc), international society for heart and lung transplantation (ishlt) (2015) Eur Respir J, 46, pp. 903-975; Naeije, R., Vachiery, J.L., Yerly, P., The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease (2013) Eur Respir J, 41, pp. 217-223; Vachiery, J.L., Adir, Y., Barbera, J.A., Pulmonary hypertension due to left heart diseases (2013) J Am Coll Cardiol, 62, pp. D100-D108; Assad, T.R., Hemnes, A.R., Larkin, E.K., Clinical and biological insights into combined post- and pre-capillary pulmonary hypertension (2016) J Am Coll Cardiol, 68, pp. 2525-2536; Delgado, J.F., Conde, E., Sanchez, V., Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure (2005) Eur J Heart Fail, 7, pp. 1011-1016; Gerges, C., Gerges, M., Lang, M.B., Diastolic pulmonary vascular pressure gradient: A predictor of prognosis in “out-of-proportion” pulmonary hypertension (2013) Chest, 143, pp. 758-766; Al-Naamani, N., Preston, I.R., Paulus, J.K., Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction (2015) JACC Heart Fail, 3, pp. 467-474; Pellegrini, P., Rossi, A., Pasotti, M., Prognostic relevance of pulmonary arterial compliance in patients with chronic heart failure (2014) Chest, 145, pp. 1064-1070; McKee, P.A., Castelli, W.P., McNamara, P.M., The natural history of congestive heart failure: The framingham study (1971) N Engl J Med, 285, pp. 1441-1446; Ponikowski, P., Voors, A.A., Anker, S.D., 2016 esc guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (esc). Developed with the special contribution of the heart failure association (hfa) of the esc (2016) Eur J Heart Fail, 18, pp. 891-975; Nagueh, S.F., Appleton, C.P., Gillebert, T.C., Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009) J Am Soc Echocardiogr, 22, pp. 107-133; Nagy, A.I., Venkateshvaran, A., Merkely, B., Determinants and prognostic implications of the negative diastolic pulmonary pressure gradient in patients with pulmonary hypertension due to left heart disease (2017) Eur J Heart Fail, 19, pp. 88-97; Tedford, R.J., Beaty, C.A., Mathai, S.C., Prognostic value of the pre-transplant diastolic pulmonary artery pressure-to-pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension (2014) J Heart Lung Transplant, 33, pp. 289-297; Adir, Y., Humbert, M., Sitbon, O., Out-of-proportion pulmonary hypertension and heart failure with preserved ejection fraction (2013) Respiration, 85, pp. 471-477; Robbins, I.M., Newman, J.H., Johnson, R.F., Association of the metabolic syndrome with pulmonary venous hypertension (2009) Chest, 136, pp. 31-36; Thenappan, T., Shah, S.J., Gomberg-Maitland, M., Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction (2011) Circ Heart Fail, 4, pp. 257-265; Borlaug, B.A., Carter, R.E., Melenovsky, V., Percutaneous pericardial resection: A novel potential treatment for heart failure with preserved ejection fraction (2017) Circ Heart Fail, 10, p. e003612; Amad, K.H., Brennan, J.C., Alexander, J.K., The cardiac pathology of chronic exogenous obesity (1965) Circulation, 32, pp. 740-745; Medoff, B.D., Okamoto, Y., Leyton, P., Adiponectin deficiency increases allergic airway inflammation and pulmonary vascular remodeling (2009) Am J Respir Cell Mol Biol, 41, pp. 397-406; Wong, C.Y., O'Moore-Sullivan, T., Leano, R., Association of subclinical right ventricular dysfunction with obesity (2006) J Am Coll Cardiol, 47, pp. 611-616; Lahm, T., Tuder, R.M., Petrache, I., Progress in solving the sex hormone paradox in pulmonary hypertension (2014) Am J Physiol Lung Cell Mol Physiol, 307, pp. L7-26; Brunner, N.W., Skhiri, M., Fortenko, O., Impact of insulin resistance on ventricular function in pulmonary arterial hypertension (2014) J Heart Lung Transpl, 33, pp. 721-726; Lam, C.S., Borlaug, B.A., Kane, G.C., Age-associated increases in pulmonary artery systolic pressure in the general population (2009) Circulation, 119, pp. 2663-2670; Kawaguchi, M., Hay, I., Fetics, B., Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: Implications for systolic and diastolic reserve limitations (2003) Circulation, 107, pp. 714-720; Paulus, W.J., Tschope, C., A novel paradigm for heart failure with preserved ejection fraction: Comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation (2013) J Am Coll Cardiol, 62, pp. 263-271; Saouti, N., Westerhof, N., Helderman, F., Right ventricular oscillatory power is a constant fraction of total power irrespective of pulmonary artery pressure (2010) Am J Respir Crit Care Med, 182, pp. 1315-1320; Thenappan, T., Prins, K.W., Pritzker, M.R., The critical role of pulmonary arterial compliance in pulmonary hypertension (2016) Ann Am Thorac Soc, 13, pp. 276-284; Tampakakis, E., Leary, P.J., Selby, V.N., The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease (2015) JACC Heart Fail, 3, pp. 9-16; Tedford, R.J., Hassoun, P.M., Mathai, S.C., Pulmonary capillary wedge pressure augments right ventricular pulsatile loading (2012) Circulation, 125, pp. 289-297

PY - 2017

Y1 - 2017

N2 - Objective The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival. Methods We retrospectively reviewed the charts of 168 PH-HFrEF and 86 PH-HFpEF patients. The independent association of PCa and DPG with prognosis was assessed by means of a Cox proportional hazard model. All cause survival was analyzed over an average follow-up period of 50 months. Results PH-HFpEF patients had a significantly higher DPG than PH-HFrEF patients (6.1 ± 7.1 vs 1.8 ± 4.5 mmHg, adjusted P =.025). PCa was similar in PH-HFpEF and PH-HFrEF. PCa was a significant predictor of survival, according to previously described preset cutoffs (2.15 mL/mmHg in HFrEF and 1.1 mL/mmHg in HFpEF) and based on a continuous scale; whereas DPG had no impact on survival in both patients groups. Conclusion Our findings suggest that for similar levels of PAWP, pulmonary circulation may be stiffer in patients with HFpEF-PH than patients with HFrEF-PH, leading to higher DPGs. Nonetheless, PCa rather than DPG emerged as the stronger predictor of survival in both left-sided PH phenotypes. © 2017 Elsevier Inc.

AB - Objective The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival. Methods We retrospectively reviewed the charts of 168 PH-HFrEF and 86 PH-HFpEF patients. The independent association of PCa and DPG with prognosis was assessed by means of a Cox proportional hazard model. All cause survival was analyzed over an average follow-up period of 50 months. Results PH-HFpEF patients had a significantly higher DPG than PH-HFrEF patients (6.1 ± 7.1 vs 1.8 ± 4.5 mmHg, adjusted P =.025). PCa was similar in PH-HFpEF and PH-HFrEF. PCa was a significant predictor of survival, according to previously described preset cutoffs (2.15 mL/mmHg in HFrEF and 1.1 mL/mmHg in HFpEF) and based on a continuous scale; whereas DPG had no impact on survival in both patients groups. Conclusion Our findings suggest that for similar levels of PAWP, pulmonary circulation may be stiffer in patients with HFpEF-PH than patients with HFrEF-PH, leading to higher DPGs. Nonetheless, PCa rather than DPG emerged as the stronger predictor of survival in both left-sided PH phenotypes. © 2017 Elsevier Inc.

KW - adult

KW - aged

KW - all cause mortality

KW - Article

KW - atrial fibrillation

KW - blood vessel compliance

KW - cardiac patient

KW - cardiovascular mortality

KW - cardiovascular parameters

KW - cohort analysis

KW - diabetes mellitus

KW - diastolic pulmonary gradient

KW - female

KW - follow up

KW - heart catheterization

KW - heart failure with preserved ejection fraction

KW - heart failure with reduced ejection fraction

KW - heart index

KW - heart output

KW - heart right atrium pressure

KW - heart right ventricle function

KW - heart stroke volume

KW - hemodynamic parameters

KW - human

KW - ischemic heart disease

KW - lung artery pressure

KW - lung circulation

KW - lung compliance

KW - lung hemodynamics

KW - lung vascular resistance

KW - lung wedge pressure

KW - major clinical study

KW - male

KW - medical record review

KW - metabolic syndrome X

KW - middle aged

KW - New York Heart Association class

KW - priority journal

KW - prognosis

KW - pulmonary artery

KW - pulmonary hypertension

KW - retrospective study

KW - smoking habit

KW - survival

KW - systemic vascular resistance

KW - systolic blood pressure

KW - tricuspid annular plane systolic excursion

KW - complication

KW - diastole

KW - echocardiography

KW - heart failure

KW - hemodynamics

KW - Hypertension, Pulmonary

KW - pathophysiology

KW - physiology

KW - time factor

KW - vascular resistance

KW - Aged

KW - Cardiac Catheterization

KW - Diastole

KW - Echocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Failure

KW - Hemodynamics

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Pulmonary Circulation

KW - Retrospective Studies

KW - Stroke Volume

KW - Time Factors

KW - Vascular Resistance

KW - Ventricular Function, Right

U2 - 10.1016/j.ahj.2017.06.006

DO - 10.1016/j.ahj.2017.06.006

M3 - Article

VL - 192

SP - 120

EP - 127

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -

Access to Document

Related content

Projects

SAN DONATO - Insufficienza Cardiaca: Nuovi Aspetti di Fisiopatologia e Rilevanza Clinica

Project: Other project