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Interaction between Pulmonary Hypertension and Diastolic Dysfunction in an elderly Heart Failure population


van Empel, Vanessa Pm; Kaufmann, Beat A; Bernheim, Alain M; Goetschalckx, Kaatje; Min, Son Y; Muzzarelli, Stefano; Pfisterer, Matthias E; Kiencke, Stephanie; Maeder, Micha T; Brunner-La Rocca, Hans-Peter (2014). Interaction between Pulmonary Hypertension and Diastolic Dysfunction in an elderly Heart Failure population. Journal of Cardiac Failure, 20(2):98-104.

Abstract

BACKGROUND: Pulmonary hypertension due to left heart disease is very common. Our aim is to investigate the relationship of the severity of left ventricular diastolic dysfunction with pre-capillary and post-capillary pulmonary hypertension (PH) in an elderly heart failure (HF) population.
METHODS AND RESULTS: A post-hoc analysis of the TIME-CHF data was done. Baseline transthoracic echocardiography was used to categorize diastolic function, to estimate pulmonary artery pressure and pulmonary-capillary wedge pressure, and calculate the transpulmonary pressure gradient (TPG). Among 392 HF patients, PH was present in 31% of patients with grade 1, in 37% of patients with grade 2, and in 65% of patients with grade 3 diastolic dysfunction. 54% of all HF patients with PH had a TPG >12 mmHg, suggesting not only a post-capillary but also an additional pre-capillary component of PH. Survival was not related to the severity of diastolic dysfunction, but was worse in patients with PH. (HR=1.63, 95%CI 1.07-2.51, p=0.024).
CONCLUSIONS: Our data indicate that HF patients with even mild diastolic dysfunction often have PH. Echocardiographic assessment suggest the presence of PH might not simply be due to increased PCWP, but in part due to a pre-capillary component.

BACKGROUND: Pulmonary hypertension due to left heart disease is very common. Our aim is to investigate the relationship of the severity of left ventricular diastolic dysfunction with pre-capillary and post-capillary pulmonary hypertension (PH) in an elderly heart failure (HF) population.
METHODS AND RESULTS: A post-hoc analysis of the TIME-CHF data was done. Baseline transthoracic echocardiography was used to categorize diastolic function, to estimate pulmonary artery pressure and pulmonary-capillary wedge pressure, and calculate the transpulmonary pressure gradient (TPG). Among 392 HF patients, PH was present in 31% of patients with grade 1, in 37% of patients with grade 2, and in 65% of patients with grade 3 diastolic dysfunction. 54% of all HF patients with PH had a TPG >12 mmHg, suggesting not only a post-capillary but also an additional pre-capillary component of PH. Survival was not related to the severity of diastolic dysfunction, but was worse in patients with PH. (HR=1.63, 95%CI 1.07-2.51, p=0.024).
CONCLUSIONS: Our data indicate that HF patients with even mild diastolic dysfunction often have PH. Echocardiographic assessment suggest the presence of PH might not simply be due to increased PCWP, but in part due to a pre-capillary component.

Citations

3 citations in Web of Science®
4 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:03 Feb 2014 13:19
Last Modified:05 Apr 2016 17:27
Publisher:Churchill Livingstone
ISSN:1071-9164
Publisher DOI:https://doi.org/10.1016/j.cardfail.2013.12.010
PubMed ID:24361805

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