@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. {\textcopyright} 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). 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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.",
}