Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

Abstract

BackgroundAlthough pulmonary hypertension due to left heart disease (LHD-PH) accounts for the largest proportion of pulmonary hypertension, few reports on the epidemiological analysis of LHD-PH exist. Recently, pulmonary arterial capacitance (PAC) has attracted attention as a possible factor of right ventricular afterload along with pulmonary vascular resistance. We therefore investigated the clinical significance of PAC in LHD-PH.MethodsThe subject consisted of 252 LHD-PH patients (145 men, mean age 63.4 ± 14.7 years) diagnosed by right heart catheterization. PAC was estimated by the ratio between stroke volume and pulmonary arterial pulse pressure. Patients were classified into four groups according to the PAC (1st quartile was 0.74 to 1.76 ml/mmHg, the 2nd quartile 1.77 to 2.53 ml/mmHg, the 3rd quartile 2.54 to 3.59 ml/mmHg, and the 4th quartile 3.61 to 12.14 ml/mmHg). The end-points were defined as rehospitalization due to worsening heart failure and/or cardiac death. The Cox proportional hazard regression model was used to determine what variables were associated with cardiac events.ResultsThe patients in the 1st quartile had the lowest cardiac index and stroke volume index, and the highest mean pulmonary arterial pressure, mean pulmonary capillary wedge pressure, and pulmonary vascular resistance compared with the 2nd, 3rd, and 4th quartiles. Fifty-four patients experienced cardiac events during the follow-up period (median 943 days). The event-free rate of the 1st quartile was significantly lower than that of the 3rd and 4th quartiles (66.7% vs 82.5% [3rd quartile], P = 0.008; and 92.1% [4th quartile], P < 0.001). The Cox hazard analysis revealed that PAC was significantly associated with cardiac events (HR 0.556, 95% CI 0.424–0.730, P < 0.001).ConclusionPAC is useful in the prediction of cardiac event risk in LHD-PH patients.

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

“…; Sugimoto et al . ). Of note, PAC was found as the strongest predictor of mortality, compared to DPG, PVR and TPG, with low PAC (<1.1 mL/mmHg) associated with nearly a fivefold increased risk of death in patients with PH‐HFpEF in a recent study (Al‐Naamani et al .…”

CSI position statement on management of heart failure in India

“…Treatment of triggering factors: In patients presenting with decompensated right ventricular failure and hemodynamic compromise, infection and anemia must be actively searched and adequately treated 533 . In patients with Eisenmenger syndrome and cor pulmonale, hyperviscocity and erythrocytosis be watched and managed accordingly 534 .…”

Assessment of pulmonary arterial compliance evaluated using harmonic oscillator kinematics

“…Although PA compliance is a major determinant of RV work 14 and has great impact on prognosis in various cardiac diseases, 1 – 4 its estimation has remained challenging. Therefore, in the present study, we chose to assess PA compliance using the PPP.…”

“…Lower pulmonary arterial (PA) compliance has recently been shown to be strongly associated with worse survival in patients with various cardiac diseases, including pulmonary arterial hypertension (PAH), 1 congenital heart disease, 2 and left ventricular dysfunction. 3 , 4 Consequently, accurate determination and serial follow-up of PA compliance are important in the management of patients with heart failure. However, despite its potential importance for right ventricular (RV) performance and clinical outcomes, PA compliance is not routinely measured because precise and reproducible quantitative assessment remains challenging.…”