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PLoS One. 2018 Jun 19;13(6):e0199164. doi: 10.1371/journal.pone.0199164. eCollection 2018.

Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: Role of the pre-capillary component.

Author information

1
Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium.
2
Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale S. Luca IRCCS Istituto Auxologico Italiano, Milan, Italy.
3
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

Abstract

BACKGROUND:

In pulmonary hypertension (PH), both wedge pressure elevation (PAWP) and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis. We aimed at describing the different haemodynamic phenotypes of patients with PH due to left heart disease (LHD) and at characterizing the impact of pulmonary haemodynamics on RV function and outcome PH-LHD.

METHODS:

Patients with PH-LHD were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n = 35). PH-LHD patients were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG<7 mmHg and pulmonary vascular resistance, PVR≤3 WU, n = 37), Combined post- and pre-capillary PH (CpcPH: DPG≥7 mmHg and PVR>3 WU, n = 27), and "intermediate" PH-LHD (either DPG <7 mmHg or PVR ≤3 WU, n = 29).

RESULTS:

Despite similar PAWP and cardiac index, haemodynamic severity and prevalence of RV dysfunction increased from IpcPH, to "intermediate" and CpcPH. PVR and DPG (but not compliance, Ca) were linearly correlated with RV dysfunction. CpcPH had worse prognosis (p<0.05) than IpcPH and PAH, but similar to "intermediate" patients. Only NTproBNP and Ca independently predicted survival in PH-LHD.

CONCLUSIONS:

In PH-LHD, haemodynamic characterization according to DPG and PVR provides important information on disease severity, predisposition to RV failure and prognosis. Patients presenting the CpcPH phenotype appear to have haemodynamic profile closer to PAH but with worse prognosis. In PH-LHD, Ca and NTproBNP were independent predictors of survival.

Conflict of interest statement

JLV is the holder of the Actelion Research Chair on Pulmonary Hypertension in his department. SC is the recipient of a ERS PAH Short-Term Research Training Fellowship (STRTF 2014-5264) supported by an unrestricted grant by GSK, and of the international grant “Cesare Bartorelli” for the year 2014 funded by the Italian Society of Hypertension. This does not alter our adherence to PLOS ONE policies on sharing data and materials. None of the other authors has a financial relationship with a commercial entity that has an interest in the subject of the present manuscript or other conflicts of interest to disclose.

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