Pulmonary vascular disease & thromboembolism
Elevated Pulmonary Artery Wedge Pressure in Group 1 Pulmonary Hypertension
Authors' conclusion
Approximately 1 in 5 adjudicated patients with group 1 PH has elevation in resting PAWP despite severe pulmonary vascular dysfunction and metabolomics consistent with traditionally defined group 1 PH. Despite resting PAWP elevation, these patients with group 1 PH were metabolomically and biologically distinct from Cpc PH HFpEF, with better left atrial function and diastolic reserve during exercise.
Study context
- Population
- Patients with adjudicated group 1 pulmonary hypertension (PH) from PVDOMICS, 2016–2019group 1 PH
- Participants
- 325 patients
- Exposure
- Group 1 PH with high pulmonary artery wedge pressure (PAWP) vs normal PAWP vs Cpc-PH heart failure with preserved ejection fraction (HFpEF)
- 1 PH+high PAWPn = 48
- Cpc-PH HFpEFn = 75
- Outcome
- Characterisation of group 1 PH with high PAWP >15 mm Hg
Methodological detailsexternal validation in 3 independent cohorts
- External validation in 3 independent cohorts
Main finding
As reported in the abstract
1 PH+high PAWP
15%
48
- Greater obesity and LV hypertrophy vs normal PAWP
- P < 0.0002
- LV strain impairment vs normal PAWP
- P < 0.0001
- Decreased LV compliance vs normal PAWP, comparable to Cpc-PH HFpEF
- P < 0.0001
- Better left atrial function vs Cpc-PH HFpEF (lower PAWP V wave, higher LA compliance and LA EF)
- P < 0.0001
- Metabolomics: little difference high vs normal PAWP; 100 metabolites altered high PAWP vs Cpc-PH HFpEF
- false discovery rate P<0.05
Observational data: associations, not effects.
Further findings
Elevated PAWP prevalence, validation cohort 1 (exercise RHC)
- Elevated PAWP in group 1 PH (n=402)
- 18%
- Exercise PAWP response intermediately abnormal in high PAWP vs Cpc-PH HFpEF and normal PAWP
- interaction P<0.0001
Elevated PAWP prevalence, validation cohorts 2 and 3
- Validation cohort 2 (n=55)
- 22%
- Validation cohort 3 (n=787)
- 19%
Original publication
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