Abstract 15937: Reactivity of the Pulmonary Artery in Heart Failure With Preserved Ejection Fraction Induced Pulmonary Hypertension Similar to Pulmonary Arterial Hypertension
Background: Recent evidence suggest that, in some, Heart Failure with Preserved Ejection Fraction results in reactive out of proportion pre-capillary pulmonary hypertension (HFpEF-rPH) similar to Pulmonary Arterial Hypertension (PAH). However, the immediate Pulmonary Artery (PA) hemodynamic response to infused Nitric Oxide (NO) has yet to be evaluated or compared to PAH NO challenge. Thus, we directly evaluated the reactivity of the PA with NO challenge in HFpEF-rPH and PAH patients naive to treatment
Methods: Prior to initiation of treatment, right heart catheterization (RHC) was conducted in consecutive patients with PAH (mPAP>25mmHg, PCWP<15mmHg and transpulmonary gradient [TPG] >12mmHg) and HFpEF-rPH (clinical symptoms of CHF, TTE parameters consistent with diastolic dysfunction, LVEF ≥50% and PASP>35mmHg on TTE, RHC mPAP>25mmHg, gradient dPAP-PCWP>12mmHg). Hemodynamic data was gathered prior to and after infusion with NO (40ppm). Patients with significant valvular disease were excluded.
Results: Patients with PAH (n=27) had a significant PVR and mPAP response to NO challenge (baseline PVR=8.6±0.7WU, NO PVR=6.2±0.6WU, p<0.001, figure A; baseline mPAP=44±2mHg, NO mPAP=37±2mmHg, p<0.001, figure B). Similarly, patients with HFpEF-rPH (n=36) had a significant PVR and mPAP response to NO (baseline PVR=5.6±0.4WU, NO PVR=3.4±0.3WU, p<0.001,figure A; baseline mPAP=41±1.6mmHg, NO mPAP=34±1.7mmHg, p<0.001, figure B). However, the magnitude of PVR and mPAP NO response was not significantly different between the two cohorts (PVR p=0.9, figure C; mPAP p=0.06, figure D).
Conclusion: This study is the first to assess the hemodynamic response to NO in patients with HFpEF-rPH and PAH. Patients with HFpEF-rPH had a significant decrease in PVR and mPAP with NO challenge that was similar to patients with PAH. This study directly demonstrates the pre-capillary PA reactivity in patients with HFpEF-rPH.
- © 2013 by American Heart Association, Inc.