Clinical Implications of Pretest Probability of HFpEF on Outcomes in Precapillary Pulmonary Hypertension

Reddy, YNV; Frantz, RP; Hassoun, PM; Hemnes, AR; Horn, E; Leopold, JA; Rischard, F; Rosenzweig, EB; Hill, NS; Erzurum, SC; Beck, GJ; Finet, JE; Jellis, CL; Mathai, SC; Tang, WHW; Borlaug, BA

doi:10.1016/j.jacc.2024.08.061

Pulmonary vascular disease & thromboembolism

Clinical Implications of Pretest Probability of Heart Failure with Preserved Ejection Fraction (HFpEF) on Outcomes in Precapillary Pulmonary Hypertension

J Am Coll CardiolPublished 23 Oct 2024Cohort study

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Authors' conclusion

Quantifying pretest probability for HFpEF in patients with group 1 PH identifies a subset of patients with worse dynamic PCWP response indicative of subclinical left heart disease, with poorer functional status, quality of life, and survival.

Study context

Population: Patients with group 1 pulmonary hypertension (PH) in the multicentre PVDOMICS studygroup 1 PH
Participants: 424 patients

Exposure: Low vs intermediate vs high pretest probability of HFpEF
Intermediaten = 228
Highn = 64
Outcome: Exercise capacity, cardiac function and hemodynamic (PCWP) responses to provocative maneuvers by HFpEF pretest probability

Methodological detailsmulticentre, secondary analysis of the PVDOMICS study

Multicentre
Secondary analysis of the PVDOMICS study

Main finding

As reported in the abstract

Intermediate54%228

High15%64

Resting pulmonary capillary wedge pressure (PCWP) increased progressively with higher HFpEF probability: P < 0.0001
High probability: greatest PCWP increases with nitric oxide, fluid challenge and exercise; comparable to HFpEF without pulmonary vascular disease (n = 194), lower than HFpEF with combined pre- and postcapillary PH: P < 0.001 for all
LV/atrial size, diastolic function, quality of life, 6-minute walk distance and peak VO2 most abnormal with high vs low or intermediate probability: P < 0.0001 for all

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
DeathPer decile of HFpEF probability	0.512	1.09 (1.05–1.13)	P < 0.0001
	0.512Hazard ratio (log scale)

Original publication

Clinical Implications of Pretest Probability of HFpEF on Outcomes in Precapillary Pulmonary Hypertension. J Am Coll Cardiol. Published 23 October 2024. doi:10.1016/j.jacc.2024.08.061

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