Pulmonary hypertension in heart failure with preserved ejection fraction: Impact on mortality and hospitalization risk in PHHF registry

Abstract

Introduction

The 2022 ESC/ERS guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). Yet, the echocardiographic profile of HF with preserved ejection fraction (PEF) patients according to their mPAP and RVP is not known.

Objective

To investigate the profile of HFPEF patients according to their mPAP and RVP.

Method

Stable HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed-up in this multicenter study. All patients had a right heart catheterization and an echocardiography within the 24 hours. PcPH was characterized by a pulmonary wedge pressure exceeding 20 mm Hg and mean mPAP greater than 20 mm Hg, from an isolated state when PVR was less than 2 Wood units (WU, IpcPH) to a combined form when PVR exceeded 2 WU (CpcPH).

Results

280 patients with HFpEF were included, with an average age of 71 years, 65% female, and 35% male. 31% of patients were hypertensive, and 39% were diabetic. Three groups were formed: patients without PH, patients with PH and resistances < 2 UW (IPC PH), and patients with PH and resistances > 2 UW (CPC PH). 13 patients (5%) did not have pulmonary hypertension, 72% had IPC PH, and 23% had CPC PH. Patients without PH had an all-cause mortality risk of 7.7% compared to 22% and 24% in the other two groups, respectively. Regarding death, there was no significant difference between the IPC PH and CPC PH groups. Regarding hospitalization, there was a 7.7% risk of hospitalization in the HFpEF group without PH versus 19% and 20% in the other two groups, respectively.

Conclusion

pEF patients with PH, CpcPH patients had worse right ventricular function despite similar remodeling when compared to IpcPH patients.