Vanessa P M van Empel1, Beat A Kaufmann2, Alain M Bernheim3, Kaatje Goetschalckx4, Son Y Min2, Stefano Muzzarelli5, Matthias E Pfisterer2, Stephanie Kiencke6, Micha T Maeder7, Hans-Peter Brunner-La Rocca8. 1. Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: vanessa.van.empel@mumc.nl. 2. Division of Cardiology, University Hospital Basel, Basel, Switzerland. 3. Division of Cardiology, University Hospital Basel, Basel, Switzerland; Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland. 4. Division of Cardiology, University Hospital Basel, Basel, Switzerland; Division of Cardiology, Leuven, Belgium. 5. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland. 6. Division of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland. 7. Division of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland. 8. Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands; Division of Cardiology, University Hospital Basel, Basel, Switzerland.
Abstract
BACKGROUND: Pulmonary hypertension due to left heart disease is very common. Our aim was to investigate the relationship of the severity of left ventricular diastolic dysfunction with precapillary and postcapillary pulmonary hypertension (PH) in an elderly heart failure (HF) population. METHODS AND RESULTS: A post hoc analysis of the Trial of Intensified Medical Therapy in Elderly Patients With Congestive Heart Failure data was done. Baseline transthoracic echocardiography was used to categorize diastolic function, estimate pulmonary artery pressure and pulmonary capillary wedge pressure, and calculate the transpulmonary pressure gradient (TPG). Among 392 HF patients, PH was present in 31% of patients with grade 1, in 37% of patients with grade 2, and in 65% of patients with grade 3 diastolic dysfunction; 54% of all HF patients with PH had a TPG >12 mm Hg, suggesting not only a postcapillary but also an additional precapillary component of PH. Survival was not related to the severity of diastolic dysfunction, but was worse in patients with PH (hazard ratio 1.63, 95% confidence interval 1.07-2.51; P = .024). CONCLUSIONS: Our data indicate that HF patients with even mild diastolic dysfunction often have PH. Echocardiographic assessment suggest that the presence of PH might not simply be due to increased PCWP, but in part due to a precapillary component.
RCT Entities:
BACKGROUND:Pulmonary hypertension due to left heart disease is very common. Our aim was to investigate the relationship of the severity of left ventricular diastolic dysfunction with precapillary and postcapillary pulmonary hypertension (PH) in an elderly heart failure (HF) population. METHODS AND RESULTS: A post hoc analysis of the Trial of Intensified Medical Therapy in Elderly Patients With Congestive Heart Failure data was done. Baseline transthoracic echocardiography was used to categorize diastolic function, estimate pulmonary artery pressure and pulmonary capillary wedge pressure, and calculate the transpulmonary pressure gradient (TPG). Among 392 HF patients, PH was present in 31% of patients with grade 1, in 37% of patients with grade 2, and in 65% of patients with grade 3 diastolic dysfunction; 54% of all HF patients with PH had a TPG >12 mm Hg, suggesting not only a postcapillary but also an additional precapillary component of PH. Survival was not related to the severity of diastolic dysfunction, but was worse in patients with PH (hazard ratio 1.63, 95% confidence interval 1.07-2.51; P = .024). CONCLUSIONS: Our data indicate that HF patients with even mild diastolic dysfunction often have PH. Echocardiographic assessment suggest that the presence of PH might not simply be due to increased PCWP, but in part due to a precapillary component.
Authors: Stephan Rosenkranz; J Simon R Gibbs; Rolf Wachter; Teresa De Marco; Anton Vonk-Noordegraaf; Jean-Luc Vachiéry Journal: Eur Heart J Date: 2015-10-27 Impact factor: 29.983