Pulmonary vascular disease & thromboembolism
Left Heart Abnormalities in Patients With Lung Disease, OSA, and Chronic Thromboemboli at Risk for or With Known Pulmonary Hypertension
Authors' conclusion
Quantifying pretest probability for HFpEF in patients with sleep apnea, lung disease, or chronic thromboemboli identifies a progressive gradient for dynamic PCWP abnormalities with worse functional status and quality of life. These subclinical left heart abnormalities are not universally detectable by resting right heart catheterization alone and call for further study of whether strategies to prevent or treat HFpEF might improve functional status in these patients with high risk of occult HFpEF.
Study context
- Population
- Adjudicated group 3 or 4 patients (lung disease, sleep apnea, chronic thromboemboli) at risk for pulmonary hypertensionpatients with group 3 disease, group 4 disease n=102 · group 3 disease 598 · group 4 disease 102 · heart failure with preserved ejection fraction (HFpEF) without pulmonary vascular disease 61 · combined precapillary and postcapillary pulmonary hypertension HFpEF 31
- Participants
- 598 participants
- Comparison
- Stratification by current resting right heart catheterization criteria, and separately by HFpEF-ABA probability
- Intermediate HFpEF probabilityn = 358
- High (≥75%) HFpEF probabilityn = 197
- Outcome
- Elevated PCWP with postcapillary pulmonary hypertension at rest (group 3)
Methodological detailsRedefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics
- Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics
Main finding
As reported in the abstract
Elevated pulmonary capillary wedge pressure (PCWP) with postcapillary pulmonary hypertension even at rest
27%
n=161
Further findings
| Outcome | Intermediate HFpEF probability | High (≥75%) HFpEF probability |
|---|---|---|
| HFpEF-ABA probability distribution (group 3)Regardless of resting PCWP-based classification | 57% | 32% |
Resting and dynamic PCWP response to NO, fluid, and exercise
- High HFpEF probability associated with higher resting and dynamic PCWP
- P < 0.0001 for all
- Comparable with HFpEF without pulmonary vascular disease (n=61); less severe than combined precapillary and postcapillary pulmonary hypertension HFpEF (n=31)
- Interaction P =0.006
Left heart remodeling, quality of life, 6-minute walk distance, peak VO 2
- Increasing HFpEF probability associated with worse outcomes
- P < 0.0001 for all
Replication in group 4 disease
- Findings were replicated in group 4 disease (n=102)
Original publication
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