Abstract 19237: Clinical Characteristics and Prognostic Impacts of Post-Capillary Reactive Pulmonary Hypertension in Patients with Left Heart Disease
Background: Post-capillary pulmonary hypertension (PH) is known as an important risk factor for poor outcome of patients with left heart disease. Although patients with elevated transpulmonary pressure gradient (TPPG; mean pulmonary artery pressure (PAP) - mean pulmonary wedge pressure) have an increased risk of post-operative right ventricular heart failure after heart transplantation, the clinical implication of post-capillary PH still remains to be clarified. In this study, we thus examined the clinical characteristics and prognostic impacts of post-capillary PH in patients with chronic heart failure (CHF) caused by left heart disease.
Methods: We examined 1,077 consecutive patients with non-ischemic CHF who underwent right heart catheterization from August 2000 to April 2010 at our hospital. Among them, 141 (13%) had post-capillary PH, including post-capillary reactive PH (TPPG>12 mmHg) in 33 and post-capillary passive PH (TPPG≤12 mmHg) in 108. They were followed up for a mean period of 1,093±81 [SE] days.
Results: The post-capillary PH group, when compared with the post-capillary passive PH group, was characterized by higher prevalence of female gender (70 vs. 36%, P=0.001) and valvular heart disease (58 vs. 40%, P<0.05). Mean PAP and pulmonary arterial stiffness were significantly elevated in the post-capillary reactive PH group compared with the post-capillary passive PH group (mean PAP 41 vs. 30 mmHg; pulmonary arterial stiffness, 0.57 vs. 0.37 mmHg/ml, both P<0.0001). Severe mitral regurgitation (Sellers' grade greater or equal to 3) was observed more frequently in the reactive PH than in the passive PH group (33 vs. 13%, P<0.05). During the follow-up period, 11 patients (33%) with reactive PH and 24 (22%) with passive PH patients died. Kaplan-Meier curve showed that 500-day mortality was significantly worse in the reactive PH than in the passive PH group (21 vs. 7%, P<0.05), whereas 3,500-day mortality was comparable between the 2 groups (52 vs. 48%).
Conclusion: These results indicate that post-capillary reactive PH is characterized by female gender, valvular heart disease and elevated PAP in patients with left heart disease and its mid-term mortality is significantly worse compared with post-capillary passive PH.
- © 2010 by American Heart Association, Inc.