RT Journal Article
SR Electronic
T1 Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: role of the pre-capillary component
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA3525
DO 10.1183/1393003.congress-2017.PA3525
VO 50
IS suppl 61
A1 Sergio Caravita
A1 Andrea Faini
A1 Antoine Bondue
A1 Robert Naeije
A1 Gianfranco Parati
A1 Jean-Luc Vachiéry
YR 2017
UL http://erj.ersjournals.com/content/50/suppl_61/PA3525.abstract
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.