Pulmonary Hemodynamics in Heart Failure Patients with Reduced or Preserved Ejection Fraction and Pulmonary Hypertension: Similarities and Disparities

• Published in: The American heart journal Vol. 192; pp. 120 - 127
• Main Authors: Adir, Yochai, MD, Guazzi, Marco, MD, PhD, Offer, Amir, MD, Temporelli, Pier Luigi, MD, Cannito, Antonia, MD, Ghio, Stefano, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017; Elsevier Limited
• Subjects: Aged; Cardiac Catheterization; Cardiovascular; Cardiovascular disease; Catheters; Charts; Circulatory system; Coronary vessels; Diastole; Echocardiography; Ejection fraction; Female; Follow-Up Studies; Heart attacks; Heart diseases; Heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - physiopathology; Hemodynamics; Hemodynamics - physiology; Humans; Hypertension; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - physiopathology; Intubation; Male; Middle Aged; Mortality; Patient compliance; Patients; Prognosis; Pulmonary arteries; Pulmonary artery; Pulmonary Circulation; Pulmonary hypertension; Retrospective Studies; Stroke; Stroke Volume; Survival; Time Factors; Transplants & implants; Vascular Resistance; Ventricle; Ventricular Function, Right; RAP; pulmonary vascular compliance; heart failure with preserved ejection fraction associated with pulmonary hypertension; TPG; PVR; diastolic pulmonary gradient; HFrEF-PH; SVR; PCa; pulmonary artery wedge pressure; right atrial pressure; pulmonary artery pressure; BMI; systemic vascular resistance; MR; mitral regurgitation; body mass index; CI; HFpEF-PH; cardiac index; trans pulmonary gradient (mPAP-PCWP); PAWP; heart failure with reduced ejection fraction associated with pulmonary hypertension; DPG; pulmonary vascular resistance; PAP
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2017.06.006

Objective The current understanding of pulmonary hypertension (PH) due to left heart 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.