Characteristics of pulmonary hypertension in adults with left ventricular diastolic dysfunction.

Background and objectives: Left ventricular diastolic dysfunction (LVDD) is commonly associated with pulmonary hypertension (PHT); however, the factors associated with the presence and severity of PHT in patients with LVDD have not been well characterised.

Methods: We analysed the profiles and echo characteristics of 16 058 adults with LVDD and preserved left ventricular ejection fraction (LVEF, >50%) from the National Echocardiography Database of Australia. Peak tricuspid regurgitation velocity (TRV) was used to determine the presence of PHT. Univariate and multivariate analyses were performed to evaluate the parameters associated with the presence/increasing severity of PHT.

Results: Mean age was 73±12 years and 9216 (57.4%) were women. 2503 (15.6%) subjects had atrial fibrillation (AF) and 13 555 (84.4%) were in sinus rhythm. Overall, 9976 (62.1%) had PHT (TRV >2.9 m/s). There was a progressive increase in indexed left atrial volume with rising TRV levels. AF and right ventricular (RV) dilation were strongly associated with the presence of PHT (adjusted OR (aOR) 1.27 (95% CI 1.12 to 1.43) and aOR 4.99 (95% CI 4.44 to 5.62), respectively). Increased age, LVEF and body mass index were also independently associated with PHT (p<0.001). On multivariate analysis, older age, female sex, AF, lower E/e' and LVEF were independently associated with the severity of PHT (p<0.001). The presence of AF increased the TRV by an average of 0.32 m/s, RV dilation by 1.82 m/s, female sex by 0.32 m/s and age (per decade) by 0.3 m/s.

Conclusion: In this large study, PHT was common in LVDD and was strongly associated with the presence of enlarged left atrium, AF and older age, in particular.

Trial registration number: ACTRN12617001387314.