Elsevier

JACC: Heart Failure

Volume 1, Issue 4, August 2013, Pages 290-299
JACC: Heart Failure

Mini Focus Issue: Right Heart Function and Pulmonary Hypertension
Clinical Features, Hemodynamics, and Outcomes of Pulmonary Hypertension Due to Chronic Heart Failure With Reduced Ejection Fraction: Pulmonary Hypertension and Heart Failure

https://doi.org/10.1016/j.jchf.2013.05.001Get rights and content
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Objectives

The purpose of this study was to assess the clinical, functional, and hemodynamic characteristics of passive and mixed pulmonary hypertension (PH), compare outcomes, and contrast conventional and novel hemodynamic partition values in patients with chronic heart failure of reduced left ventricular ejection fraction (HFREF).

Background

PH in HFREF may develop from left-sided venous congestion (passive PH) or the combination of pulmonary arterial disease and venous congestion (mixed PH). Subgroup outcomes are not well defined, and the partition values used to define risk are based largely on consensus opinion rather than outcome data.

Methods

Ambulatory patients referred for hemodynamic catheterization were analyzed retrospectively (N = 463).

Results

Comparing patients with no PH to those with passive PH and mixed PH, a progressive gradient of more severely deranged hemodynamics, diastolic dysfunction, and mitral regurgitation was observed. In multivariate analysis, the presence of any PH or mixed PH was associated with older age, diuretic use, atrial fibrillation, and lower pulmonary artery compliance (PAC). Over a median follow-up of 2.1 years, patients with PH displayed greater risk of death (hazard ratio [HR]: 2.24; confidence limits [95% CL]: 1.39, 3.98; p < 0.001) with mixed PH demonstrating greater risk than passive PH (HR: 1.55; 95% CL: 1.11, 2.20; p < 0.001). Partition values identifying highest risk were pulmonary vascular resistance >4 Wood units, systolic pulmonary artery pressure >35 mm Hg, pulmonary wedge pressure >25 mm Hg, and PAC <2.0 ml/mm Hg.

Conclusions

Among stable HFREF outpatients, PH was associated with markers of greater disease severity and risk of death. However, the presence of pulmonary arterial disease (mixed PH) carries incremental risk. Abnormalities in pulmonary vascular resistance and compliance may serve as novel therapeutic targets.

Key Words

heart failure
mixed pulmonary hypertension
outcomes
passive pulmonary hypertension
risk prediction

Abbreviations and Acronyms

ADHF
acute decompensated heart failure
HFREF
heart failure of reduced left ventricular ejection fraction
PAC
pulmonary artery compliance
PH
pulmonary hypertension

Cited by (0)

This study was supported by the Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.