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Predictors of Outcome in Patients with Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction

Nadine Al-Naamani


S. Richter

Ioana Preston


Nicholas Hill


K. E. Roberts

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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Al-Naamani N, Richter S, Preston I, Hill N, Roberts KE.

Tufts Medical Center, Boston, MA, USA

BACKGROUND: Pulmonary hypertension due to left heart disease, WHO Group II, is the most common form of pulmonary hypertension and its presence is an independent predictor of mortality. Patients with left sided heart failure with preserved ejection fraction (HFpEF) have elevated pulmonary artery pressures because of increased left-sided filling pressure with normal pulmonary vascular resistance (PVR) or transpulmonary gradient (TPG). A subset of HFpEF patients have elevated PVR and TPG and are referred to as PH-HFeEF. This study evaluates the predictors of mortality in patients with HFpEF and PH-HFpEF.

METHODS: This is a prospective cohort study of consecutive patients undergoing diagnostic right heart catheterization for suspected pulmonary hypertension at Tufts Medical Center from January 2004 to March 2012. Subjects were included if they had a mPA > 25 and PW > 15 mm Hg. PH-HFpEF was defined as having PVR > 240 dynes.sec.cm-5 and /or TPG > 12 mm Hg. Continuous data were summarized using mean +/- SD and categorical variables summarized with n (%). Survival was assessed using the Kaplan-Meier estimator and Cox proportional hazards models.

RESULTS: We identified 51 patients with Group II pulmonary hypertension, of whom 39 patients met the criteria for PH-HFpEF. Baseline characteristics are found in the Table. Patients with PH-HFpEF and HFpEF were similar in terms of age, gender, race, body mass index and cardiac output. The majority of the patients (76%) were classified as New York Heart Association functional class II or III at the time of catheterization. PH-HFpEF was not associated with an increased risk of death (HR 0.49, p 0.36). After adjusting for age and sex, cardiac output and mPA were independently associated with the risk of death (HR 0.51, 1.08; p 0.04 and 0.02, respectively) in all patients with HFpEF and PH-HFpEF.

CONCLUSIONS: In our cohort the presence of PH is not associated with increased risk of death among subjects with HFpEF. Cardiac output was independently associated with better outcomes and mean pulmonary artery pressure was independently associated with worse outcomes. 

                                                                                   HFePF

                                                                                    (n=12)

PH-HFpEF (n=39)

P value

Age, years

70 ± 12

68 ± 12

0.53

Female, n (%)

8 (67%)

30 (77%)

0.48

Caucasian, n (%)

12 (100%)

36 (92%)

0.32

Body mass index, kg/m2

32 ± 7

33 ± 11

0.88

Right atrial pressure, mm Hg

12 ± 4

14 ± 5

0.20

Mean pulmonary artery pressure, mm Hg

31 ± 5

44 ± 11

<0.001

Mixed venous oxygen saturation, %

67 ± 4

63 ± 9

0.12

Pulmonary capillary wedge pressure, mm Hg

22 ± 5

21 ± 4

0.49

Cardiac output, L/min

5.2 ± 1.4

4.6 ± 1.5

0.21

Cardiac index, L/min/m2

2.7 ±0.7

2.4 ± 0.7

0.19

Pulmonary vascular resistance, dynes.sec.cm-5

141 ±47

469 ± 338

0.003