Association Between Hemodynamic Markers of Pulmonary Hypertension and Outcomes in Heart Failure With Preserved Ejection Fraction

Vanderpool, Rebecca; Saul, Melissa; Nouraie, Mehdi; Gladwin, Mark T.; Simon, Marc A.

doi:10.1001/jamacardio.2018.0128

Cited by 177 publications

(182 citation statements)

References 51 publications

(86 reference statements)

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“…The presence of an elevated PVR has been associated with an increased risk for hospitalization and prolonged hospital stays in non-transplant patients. 37,38 We could not detect a statistically significant difference between patients with and without a PVR ≥ 300 dyn·s·cm À5 in the length of the initial hospital stay after HTX. This may be due to the fact that patients with a PVR ≥ 300 dyn·s·cm À5 had a considerably higher 30 day mortality after HTX.…”

Section: Length Of the Initial Hospital Stay And Early Atrial Fibrillmentioning

confidence: 66%

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

et al. 2020

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Aims Severely elevated pre‐transplant pulmonary vascular resistance (PVR) has been linked to adverse effects after heart transplantation (HTX). The impact of a moderately increased PVR before HTX on post‐transplant outcomes remains uncertain. The aim of this study was to investigate the effects of an elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) on outcomes after HTX. Methods and results This observational retrospective single‐centre study included 561 patients receiving HTX at Heidelberg Heart Center between 1989 and 2015. Patients were stratified by degree of pre‐transplant PVR. Analyses covered demographics, post‐transplant medication, mortality and causes of death after HTX, early post‐transplant atrial fibrillation (AF), and length of the initial hospital stay after HTX. Ninety‐four patients (16.8%) had a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). These patients had a higher rate of early post‐transplant AF [20.2 vs. 10.7%, difference: 9.5%, 95% confidence interval (CI): 0.9–18.1%, P = 0.01] and an increased 30 day post‐transplant mortality (25.5 vs. 6.4%, hazard ratio: 4.4, 95% CI: 2.6–7.6, P < 0.01), along with a higher percentage of death due to transplant failure (21.2 vs. 4.1%, difference: 17.1%, 95% CI: 8.7–25.5%, P < 0.01). Multivariate analysis revealed a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) as a significant risk factor for increased 30 day mortality after HTX (hazard ratio: 4.4, 95% CI: 2.5–7.6, P < 0.01). Kaplan–Meier estimator showed a lower 2 year survival after HTX (P < 0.01) in patients with a PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units). Conclusions Elevated pre‐transplant PVR ≥ 300 dyn·s·cm−5 (≥3.75 Wood units) is associated with early post‐transplant AF and increased mortality after HTX.

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Section: Length Of the Initial Hospital Stay And Early Atrial Fibrillmentioning

confidence: 66%

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

et al. 2020

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“…; Vanderpool et al . ). Despite increasing interest and a growing number of related publications, no approved specific medication or consensus therapeutic strategy for PH‐HFpEF is available at present, mainly due to significant gaps in understanding of the pathophysiological processes and parameters that can help to accurately define PH‐HFpEF, as well as the complex associated comorbidities seen with HFpEF in general (metabolic syndrome, renal dysfunction, advancing age, etc.).…”

Section: Definitions Classification Of Subtypes and Diagnostic Factomentioning

confidence: 97%

“…In accord with this, a large retrospective cohort study (Pittsburgh cohort, single centre with 10,023 subjects undergoing right heart catheterization during 2005–2012) revealed that multiple haemodynamic definitions of the pre‐capillary component (elevated DPG, PVR and TPG) all independently predicted mortality and cardiac hospitalizations in patients with CpcPH‐HFpEF (Vanderpool et al . ). This study found that TPG >12 mmHg (an easily obtained measure) captures more patients as having CpcPH and independently predicts hospitalization and increased mortality in patients with HFpEF.…”

Section: Definitions Classification Of Subtypes and Diagnostic Factomentioning

confidence: 97%

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Lai

Wang

Gladwin

2018

The Journal of Physiology

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Pulmonary hypertension in the setting of heart failure with preserved ejection fraction (PH-HFpEF) is a growing public health problem that is increasing in prevalence. While PH-HFpEF is defined by a high mean pulmonary artery pressure, high left ventricular end-diastolic pressure and a normal ejection fraction, some HFpEF patients develop PH in the presence of pulmonary Yen-Chun (Charly) Lai is an Assistant Professor at Indiana University. Her lab focuses primarily on investigating pathogenesis and development of alternative therapies for effective treatment of cardiopulmonary diseases, with the particular emphasis of metabolic syndrome, pulmonary hypertension and heart failure with preserved ejection fraction. Mark Gladwin is a Jack D. Myers Professor and Chair at University of Pittsburgh. He is recognized internationally as an expert in pulmonary hypertension, having described the pathobiology and clinical characteristics of pulmonary hypertension in patients with sickle cell disease and other chronic hereditary and acquired haemolytic diseases. He served on the Dana Point Pulmonary Hypertension Classification Committee and co-authored the report. He served on the NHLBI advisory committee to develop the 'Strategic Plan for Lung Vascular Research' . He has authored more than 10 textbook chapters on pulmonary vascular disease and has published over 100 papers on the topic of pulmonary hypertension alone. vascular remodelling with a high transpulmonary pressure gradient or pulmonary vascular resistance. Ageing, increased left atrial pressure and stiffness, mitral regurgitation, as well as features of metabolic syndrome, which include obesity, diabetes and hypertension, are recognized as risk factors for PH-HFpEF. Qualitative studies have documented that patients with PH-HFpEF develop more severe symptoms than those with HFpEF and are associated with more significant exercise intolerance, frequent hospitalizations, right heart failure and reduced survival. Currently, there are no effective therapies for PH-HFpEF, although a number of candidate drugs are being evaluated, including soluble guanylate cyclase stimulators, phosphodiesterase type 5 inhibitors, sodium nitrite and endothelin receptor antagonists. In this review we attempt to provide an updated overview of recent findings pertaining to the pulmonary vascular complications in HFpEF in terms of clinical definitions, epidemiology and pathophysiology. Mechanisms leading to pulmonary vascular remodelling in HFpEF, a summary of pre-clinical models of HFpEF and PH-HFpEF, and new candidate therapeutic strategies for the treatment of PH-HFpEF are summarized. Abstract figure legendPrevalence and pathophysiology of pulmonary hypertension (PH) in patients with heart failure with preserved ejection fraction (HFpEF). LA, left atrium; LV, left ventricle; LVEDP, left ventricular end-diastolic pressure; PA, pulmonary artery/arterial; PV, pulmonary vein; PVR, pulmonary vascular resistance; RV, right ventricle. Definitions, classification of subtypes and diagnostic factors of...

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“…A recent analysis [16] revealed that this applied for 28.7% of patients with PH-LHD undergoing right heart catheterization, in whom only one of the variables was elevated. Furthermore, recent studies revealed that a PVR N 3 WU was predictive of survival in patients with PH-LHD and outperformed other measures such as TPG or DPG (see also below) [17][18][19]. Given this new evidence, it appears appropriate to define CpcPH primarily by a PVR N 3 WU, although a DPG ≥ 7 mmHg as well as a pulmonary arterial compliance (PA C ) b 2,3 ml/mmHg may also be considered.…”

Section: Definitions Pathophysiology and Classificationmentioning

confidence: 99%

“…Comments: Hemodynamic parameters that have prognostic significance in PH due to heart failure include elevated PAWP, mPAP and PVR, as well as reduced PA C [11,[17][18][19]22,[29][30][31][32][33][34], while no significance was demonstrated for the TPG at a threshold of 12 mmHg [11]. Findings from recently published studies on the predictive value of the DPG in different heart failure populations yielded conflicting results [12,[17][18][19]22,33,34]. This may be attributable to differing populations and methodological limitations [35].…”

Section: 1-22 Pulmonary Hypertension Due To Heart Failurementioning

confidence: 99%

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Rosenkranz

Lang

Blindt

et al. 2018

International Journal of Cardiology

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Association Between Hemodynamic Markers of Pulmonary Hypertension and Outcomes in Heart Failure With Preserved Ejection Fraction

Abstract: In a large cohort referred for invasive hemodynamic assessment, PH-HFpEF was common. Transpulmonary gradient, pulmonary vascular resistance, and diastolic pulmonary gradient are all associated with mortality and cardiac hospitalizations.

Cited by 177 publications

References 51 publications

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

Elevated pre‐transplant pulmonary vascular resistance is associated with early post‐transplant atrial fibrillation and mortality

Insights into the pulmonary vascular complications of heart failure with preserved ejection fraction

Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

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