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 journalArticle

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

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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

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