Pulmonary vascular disease & thromboembolismCohort study
Clinical Implications of Pretest Probability of Heart Failure with Preserved Ejection Fraction (HFpEF) on Outcomes in Precapillary Pulmonary Hypertension
- Cohort study
- multicentre
- secondary analysis of the PVDOMICS study
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
Main finding
As reported in the abstract
- 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 | HR (95% CI) | P value | |
|---|---|---|---|
| Death · per decile of HFpEF probability | 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
Summarised from the published abstract; every number is checked against it