PT  - JOURNAL ARTICLE
AU  - Sergio Caravita
AU  - Andrea Faini
AU  - Antoine Bondue
AU  - Robert Naeije
AU  - Gianfranco Parati
AU  - Jean-Luc Vachiéry
TI  - Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: role of the pre-capillary component
AID  - 10.1183/1393003.congress-2017.PA3525
DP  - 2017 Sep 01
TA  - European Respiratory Journal
PG  - PA3525
VI  - 50
IP  - suppl 61
4099  - http://erj.ersjournals.com/content/50/suppl_61/PA3525.short
4100  - http://erj.ersjournals.com/content/50/suppl_61/PA3525.full
SO  - Eur Respir J2017 Sep 01; 50
AB  - Background: In pulmonary hypertension (PH), both wedge pressure elevation and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis.Aim: To characterize the impact of pulmonary haemodynamics on RV function and outcome in patients with PH.Methods: Patients with PH due to left heart disease (LHD) were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n=35). PH-LHD were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG<7 mmHg and pulmonary vascular resistance, PVR≤3 WU, n=37), Combined post- and pre-capillary PH (CpcPH: DPG≥7 and PVR>3, n=27), and “indeterminate” PH (DPG > 7mmHg or PVR > 3WU, n=29)..Results: Despite similar PAWP and PVR, haemodynamic severity and prevalence of RV failure increased from IpcPH, to “indeterminate” and CpcPH. PVR and DPG (but not compliance, Ca) were linearly correlated with RV failure (figure). CpcPH had worse prognosis (p<0.05) than IpcPH (HR 0.302) and PAH (HR 0.346), but similar to “indeterminate” patients. Only NTproBNP and Ca independently predicted survival in PH-LHD.Conclusions: Haemodynamic characterization of PH-LHD is associated with disease severity, predisposition to RV failure and prognosis. Ca and NTproBNP were independent predictors of survival.