Emmanuelle Berthelot1, David Montani2, Vincent Algalarrondo3, Céline Dreyfuss4, Raed Rifai4, Anouar Benmalek5, Xavier Jais2, Amir Bouchachi4, Laurent Savale2, Gerald Simonneau2, Denis Chemla6, Marc Humbert2, Olivier Sitbon2, Patrick Assayag7. 1. AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. Electronic address: emmanuelle.berthelot@aphp.fr. 2. Univ. Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, DHU Thorax Innovation (DHU TORINO), Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, LabEx LERMIT, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 3. Univ. Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Cardiologie, Hôpital Béclère, Clamart, France. 4. AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 5. Faculté de Pharmacie, Châtenay-Malabry Cedex, and INSERM UMR_S 1180, Chatenay-Malabry, France. 6. AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; AP-HP, Service de Physiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France. 7. AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Univ. Paris-Sud, Le Kremlin-Bicêtre, France.
Abstract
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a frequent cause of pulmonary hypertension (PH) that is not easy to differentiate from precapillary PH. We aimed to determine whether the characteristic features of the patients may help differentiate between HFpEF and precapillary PH. METHODS AND RESULTS: Clinical and echocardiographic parameters were analyzed in 156 patients referred to our PH referral center. Right heart catheterization identified 78 PH-HFpEF patients and 78 with precapillary PH. Compared with precapillary PH, PH-HFpEF patients were older, with a smaller proportion of women, a higher proportion of hypertension, diabetes mellitus, atrial fibrillation and sleep apnea syndrome, and a higher body mass index. On echocardiography, PH-HFpEF patients had higher left ventricular mass index, higher left atrial area, and smaller right ventricular end-diastolic area. Following multivariate analysis, a model predicting the probability of PH-HFpEF was built with history of diabetes mellitus, presence of atrial fibrillation, left atrial area, right ventricular end-diastolic area, and left ventricular mass index. The score was internally validated using bootstrap method (area under the curve 0.93 [95% confidence interval 0.918-0.938]). A score <5 ruled out PH-HFpEF. CONCLUSION: A score including clinical and echocardiographic criteria may help physicians to identify PH-HFpEF from precapillary PH.
BACKGROUND:Heart failure with preserved ejection fraction (HFpEF) is a frequent cause of pulmonary hypertension (PH) that is not easy to differentiate from precapillary PH. We aimed to determine whether the characteristic features of the patients may help differentiate between HFpEF and precapillary PH. METHODS AND RESULTS: Clinical and echocardiographic parameters were analyzed in 156 patients referred to our PH referral center. Right heart catheterization identified 78 PH-HFpEF patients and 78 with precapillary PH. Compared with precapillary PH, PH-HFpEF patients were older, with a smaller proportion of women, a higher proportion of hypertension, diabetes mellitus, atrial fibrillation and sleep apnea syndrome, and a higher body mass index. On echocardiography, PH-HFpEF patients had higher left ventricular mass index, higher left atrial area, and smaller right ventricular end-diastolic area. Following multivariate analysis, a model predicting the probability of PH-HFpEF was built with history of diabetes mellitus, presence of atrial fibrillation, left atrial area, right ventricular end-diastolic area, and left ventricular mass index. The score was internally validated using bootstrap method (area under the curve 0.93 [95% confidence interval 0.918-0.938]). A score <5 ruled out PH-HFpEF. CONCLUSION: A score including clinical and echocardiographic criteria may help physicians to identify PH-HFpEF from precapillary PH.
Authors: Olga Dzikowska-Diduch; Katarzyna Kurnicka; Barbara Lichodziejewska; Olga Zdończyk; Dominika Dąbrowska; Marek Roik; Szymon Pacho; Maksymilian Bielecki; Piotr Pruszczyk Journal: J Clin Med Date: 2022-02-18 Impact factor: 4.241