Even though heart failure with preserved ejection fraction (HFpEF) is common, there are no particular treatments available, probably due to phenotypic heterogeneity. The development of pulmonary hypertension (PH) in patients with HFpEF is considered a high-risk phenotype that requires targeted therapy, but hemodynamic and outcome data are sparse. For a study, the researchers wanted to determine the hemodynamic features and consequences of PH-HFpEF. The researchers looked at a cohort analysis of people who underwent a right cardiac catheterization between January 2005 and September 2012 (median [interquartile range] follow-up time, 1,578 [554-2513] days). The clinical data repository of all inpatient and outpatient interactions across a health system was linked to hemodynamic catheterization data. For a study, the researchers looked at a single tertiary referral facility for heart failure and PH within a big health care network that used a common clinical data repository. In total, 19,262 operations were performed on 10,023 subjects. Participants were divided into three groups: those with no PH, those with precapillary PH, and those with PH in the context of left heart disease (reduced or preserved ejection fraction). A mean pulmonary artery pressure of 25 mm Hg or more, a pulmonary artery wedge pressure of 15 mm Hg or more, and a left ventricular ejection fraction of 45% or higher were used to identify pulmonary hypertension associated with HFpEF. The hemodynamic indices transpulmonary gradient, pulmonary vascular resistance, and diastolic pulmonary gradient were used to assess the severity of pulmonary hypertension. The time to all-cause mortality was the primary outcome. Time to acute hospitalization and cardiovascular hospitalization were secondary outcomes. All of the participants in the study had a mean age of 65 (38) years. 2587 (25.8%) of the 10,023 people tested positive for PH-HFpEF. In 1 year, 23.6% of people died, and in 5 years, 48.2% died. Cardiac hospitalizations occurred in 28.1 percent of 1-year participants and 47.4% of 5-year participants. The prevalence of precapillary PH was 12.6%, 8.8%, and 3.5%, respectively, using clinically specified cut-offs for transpulmonary gradient (more than 12 mm Hg), pulmonary vascular resistance (3 Woods units), and diastolic pulmonary gradient (7 mm Hg). Mortality and cardiac hospitalizations were linked to the transpulmonary gradient, pulmonary vascular resistance, and diastolic pressure gradient. PH-HFpEF was prevalent in a large cohort referred for invasive hemodynamic evaluation. Mortality and cardiac hospitalizations are linked to the transpulmonary gradient, pulmonary vascular resistance, and diastolic pulmonary gradient.
Link:jamanetwork.com/journals/jamacardiology/fullarticle/2674721?resultClick=1
