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Relationship Of NYHA Functional Class To Hemodynamics And Survival In Heart Failure With Preserved Ejection Fraction

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Nadine Al-Naamani II

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Group 2 pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized entity leading to symptomatic heart failure and is associated with poor outcomes.

Background: Group 2 pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized entity leading to symptomatic heart failure and is associated with poor outcomes. We hypothesized that NYHA functional classification (NYHA FC) would be associated with survival and hemodynamic measures in patients with Group 2 PH/HFpEF.

Methods: We performed a cross-sectional analysis of a prospective cohort of Group 2 PH patients who presented for right heart catheterization (RHC) at our medical center from January 2004 – September 2012. Patients were included if they were adults >18 years, with a mean pulmonary artery pressure >25 mmHg, pulmonary capillary wedge pressure >15 mmHg and preserved ejection fraction by echocardiogram (>50%). NYHA FC and Plasma brain natriuretic peptide (BNP) were assessed at the time of RHC. A six minute walk distance (6MWD) was obtained within 3 months of RHC. Pulmonary artery capacitance (PAC) was calculated from the RHC measurements. Patients were followed till death or October 1, 2013. Independent sample t-tests were used to assess the significance of differences between means and Kaplan Meier analysis was used to estimate survival.

Results: The study sample included 74 patients with Group 2 PH and HFpEF. The mean age was 69 ± 11 years and 75% were female. At the time of RHC, 33 patients were NYHA FC I/II and 41 patients were NYHA FC III/VI. Mean PAC and mean 6 MWD were significantly different between NYHA class I/II and class III/IV (2.5 ml/mmHg vs 1.9 ml/mmHg, p = 0.05; 326 m vs 221 m, p = 0.03, respectively). There was a trend toward higher mean BNP in more functionally impaired patients (407 pg/ml vs 232 pg/ml, p = 0.07). PAC and plasma BNP levels were inversely correlated (r -0.49, p < 0.001). There were 25 deaths during the study period. NYHA class I/II had a significantly better survival than the NYHA class III/IV (Figure 1, p = 0.01).

Conclusions: Shorter 6MWDs and lower PACs were associated with worse NYHA FC which in itself was associated with worse mortality. The NYHA functional classification at time of presentation is a non-invasive measure that correlates with the stiffness of the pulmonary arterial system measured invasively and can predict survival.

Type: Clinical Science