Hemodynamic Effects of Pulmonary Arterial Hypertension-Specific Therapy in Patients With Heart Failure With Preserved Ejection Fraction and With Combined Post- and Precapillay Pulmonary Hypertension

•In patients with heart failure with preserved ejection fraction and combined post- and precapillary pulmonary hypertension, pulmonary arterial hypertension-specific therapy increased stroke volume.•Pulmonary arterial hypertension-specific therapy reduced right ventricular afterload.•The increase in...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of cardiac failure Vol. 26; no. 1; pp. 26 - 34
Main Authors:	Huis in’t Veld, Anna E., Oosterveer, Frank P.T., De man, Frances S., Marcus, J. TIM, Nossent, Esther J., Boonstra, Anco, Van rossum, A.C. (Bert), Vonk Noordegraaf, Anton, Bogaard, Harm jan, Handoko, M. Louis
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-01-2020
Subjects:	Adrenergic beta-Antagonists - administration & dosage Aged Aged, 80 and over Capillaries - physiopathology Cohort Studies Diuretics - administration & dosage Drug Therapy, Combination Female Heart failure Heart Failure - diagnostic imaging Heart Failure - drug therapy Heart Failure - physiopathology Hemodynamics - drug effects Hemodynamics - physiology Humans Hypertension, Pulmonary - diagnostic imaging Hypertension, Pulmonary - drug therapy Hypertension, Pulmonary - physiopathology Magnetic Resonance Imaging, Cine - methods Male Middle Aged Prospective Studies pulmonary hypertension right ventricular function Stroke Volume - drug effects Stroke Volume - physiology Treatment Outcome Heart failure pulmonary hypertension right ventricular function
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	•In patients with heart failure with preserved ejection fraction and combined post- and precapillary pulmonary hypertension, pulmonary arterial hypertension-specific therapy increased stroke volume.•Pulmonary arterial hypertension-specific therapy reduced right ventricular afterload.•The increase in stroke volume was accompanied by an increase in left ventricular filling pressures. Drugs approved for pulmonary arterial hypertension have been considered for patients with heart failure with preserved ejection fraction and combined post- and precapillary pulmonary hypertension (Cpc-PH). We aimed to study changes in cardiac volumes, cardiac load and left ventricular (LV) filling pressures in patients with heart failure with preserved ejection fraction and Cpc-PH in response to pulmonary arterial hypertension-specific treatment. In this prospective study, 23 patients with heart failure with preserved ejection fraction and Cpc-PH underwent right-heart catheterization, including acute provocation testing (fluid loading and inhaled nitric oxide) and cardiac MRI at baseline. Right-heart catheterization and cardiac MRI were repeated after 4 months of treatment. At baseline, acutely increasing preload by fluid loading resulted in a significant increase in pulmonary arterial wedge pressure (PAWP), whereas reducing right ventricular (RV) afterload and increasing LV distensability by acute administration of inhaled nitric oxide had no effect on PAWP. After 4 months of treatment, we observed a significant reduction in RV and LV afterload and increased RV and LV stroke volume, but PAWP significantly increased. In patients with heart failure with preserved ejection fraction and Cpc-PH, 4 months of pulmonary arterial hypertension-specific treatment increased RV and LV stroke volume at the expense of increased PAWP. This increase in PAWP was similarly observed acutely after fluid loading.
ISSN:	1071-9164 1532-8414
DOI:	10.1016/j.cardfail.2019.07.547