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.
van Empel, Vanessa Pm