Pulmonary hypertension due to left heart disease: analysis of survival according to the haemodynamic classification of the 2015 <scp>ESC</scp>/<scp>ERS</scp> guidelines and insights for future changes

Palazzini, Massimiliano; Dardi, Fabio; Manes, Alessandra; Reggiani, Maria Letizia Bacchi; Gotti, Enrico; Rinaldi, Andrea; Albini, Alessandra; Monti, Enrico; Galiè, Nazzareno

doi:10.1002/ejhf.860

Cited by 88 publications

(113 citation statements)

References 19 publications

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“…At present, an almost equal number of studies have confirmed [41][42][43] or refuted [44][45][46] the prognostic relevance of DPG. These discrepancies are explained by the fact that the DPG represents a small number, is exposed to instability, as shown in studies where high DPGs were sometimes found in patients with a normal PVR 44 or where DPG was reported as negative in a proportion of patients, 47 conditions which are both physiologically impossible.…”

Section: The Diastolic Pulmonary Pressure Gradientmentioning

confidence: 98%

Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure

Naeije

Gerges

Vachiéry

et al. 2017

Circ: Heart Failure

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ABSTRACT:Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU). This combination of criteria defines isolated postcapillary PH. Postcapillary PH with elevated vascular gradients and pulmonary vascular resistance defines combined post-and precapillary PH (Cpc-PH). Postcapillary PH is associated with a decreased survival in proportion to increased pulmonary vascular gradients, decreased pulmonary arterial compliance, and reduced right ventricular function. The Cpc-PH subcategory occurs in 12% to 13% of patients with PH due to left heart disease. Patients with Cpc-PH have severe PH, with higher diastolic pulmonary pressure gradient, transpulmonary pressure gradient, and pulmonary vascular resistance and more pronounced ventilatory responses to exercise, lower pulmonary arterial compliance, depressed right ventricular ejection fraction, and shorter life expectancy than isolated postcapillary PH. Cpc-PH bears similarities to pulmonary arterial hypertension. Whether Cpc-PH is amenable to therapies targeting the pulmonary circulation remains to be tested by properly designed randomized controlled trials.

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Section: The Diastolic Pulmonary Pressure Gradientmentioning

confidence: 98%

Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure

Naeije

Gerges

Vachiéry

et al. 2017

Circ: Heart Failure

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“…First, all haemodynamic parameters measured by RHC, including PAP, are dependent on blood pressure, cardiac function (CO, LV, and RV function), and blood volume. Second, neither the TPG nor the DPG has clearly shown any incremental prognostic value (rehospitalization and cardiovascular death) . Third, PVC and PVRs seem to be the two most interesting parameters, but they are strongly related to the CO and therefore cannot be interpreted independently …”

Section: Do the Various Definitions Of Post‐capillary Pulmonary Hypermentioning

confidence: 93%

“…Consequently, the prevalence of PH in these cohorts is particularly high and cannot be extrapolated to the overall population of HF patients . Regarding the prevalence of increased DPG, it is estimated to range between 12% and 38% in HF patients . Cpc‐PH is rare in CHF and characterized by younger age, chronic obstructive pulmonary disease, and worse RV–PA coupling.…”

Section: Do the Various Definitions Of Post‐capillary Pulmonary Hypermentioning

confidence: 99%

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

et al. 2018

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Pulmonary hypertension (PH) is a common and severe complication of heart failure (HF). Consequently, HF is the leading cause of PH. For many years, specialists have attempted to better understand the pathophysiology of PH in HF, to define its prevalence and its impact on prognosis in order to improve the therapeutic management of these patients. Nowadays, despite the recent guidelines published on the subject, several points remain unclear or debated, and until now, no study has demonstrated the efficacy of any treatment. The aim of this review is to report the evolution of the concepts on post‐capillary PH (diagnosis, prevalence, prognosis, and therapeutics). The main issues are raised, focusing especially on the link between structural alterations and haemodynamic abnormalities, to discuss the possible reasons for treatment failures and future potential targets.

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“…The authors also showed that, in addition to PVR, pulmonary arterial compliance (PAC), calculated as stroke volume divided by pulse pressure (difference between systolic and diastolic PAP), was also predictive of survival. In fact, a low PAC turned out to be the strongest predictor of death when analysed as a continuous variable ( P = 0.001) …”

mentioning

confidence: 98%

“…In this issue of the Journal, Palazzini et al . add another piece to the puzzle . They present a retrospective, single‐centre analysis of 276 patients with LHD who underwent invasive haemodynamic assessment between 1997 and 2015, in whom post‐capillary PH (mean PAP ≥25 mmHg; mean PAWP >15 mmHg) was diagnosed.…”

mentioning

confidence: 99%

Pulmonary vascular indices and survival in left heart disease: illusion of conclusion?

Rosenkranz

Hoeper

2017

European J of Heart Fail

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Pulmonary hypertension due to left heart disease: analysis of survival according to the haemodynamic classification of the 2015 ESC/ERS guidelines and insights for future changes

Abstract: Patients with Ipc-PH have a better prognosis compared with patients with Cpc-PH and with patients with isolated increase of PVR or DPG. Pulmonary vascular resistance has a better predictive value than DPG in patients with PH-LHD.

Cited by 88 publications

References 19 publications

Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure

Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure

Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues

Pulmonary vascular indices and survival in left heart disease: illusion of conclusion?

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