Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction: A Community-Based Study

By C. Lam, Véronique L. Roger, R. Rodeheffer, Barry A. Borlaug, F. Enders, M. Redfield. Journal of the American College of Cardiology, 2009

1,067 citations recorded by the source corpus.

Objectives To define the prevalence, severity and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in the general community. Background While HFpEF is known to cause PH, its development is highly variable. Population-based data are lacking, and the relative contribution of pulmonary venous versus pulmonary arterial hypertension to PH in HFpEF is unknown. We hypothesized that PH would be a marker of symptomatic pulmonary congestion, distinguishing HFpEF from preclinical hypertensive heart disease (HTN). Methods Population-based study of 244 HFpEF patients (76±13y; 45%male) followed from Doppler echocardiography over 3 years. Controls were 719 adults with HTN without HF (66±10y; 44%male). Pulmonary artery systolic pressure (PASP) was derived from the tricuspid regurgitation velocity and PH defined as PASP>35 mmHg. Pulmonary capillary wedge pressure (PCWP) was estimated from E/e’. Results In HFpEF, PH was present in 83% and median (25th, 75th percentile) PASP was 48 (37, 56) mmHg. PASP increased with PCWP (r=0.21; p<0.007). Adjusting for PCWP, PASP was higher in HFpEF than HTN (p<0.001). PASP distinguished HFpEF from HTN with an area under receiver-operating curve of 0.91 (p<0.001) and strongly predicted mortality in HFpEF (hazard ratio=1.3 per 10 mmHg; p<0.001). Conclusions PH is highly prevalent and often severe in HFpEF. While pulmonary venous hypertension contributes to PH, it does not fully account for the severity of PH in HFpEF, suggesting that a component of pulmonary arterial hypertension also contributes. The potent effect of PASP on mortality lends support for therapies aimed at pulmonary arterial hypertension in HFpEF.

Subfields: Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine

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Citations in the corpus

Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. (2011, background): “Vascular dysfunction is not confined to the systemic circulation in HFpEF, as pulmonary hypertension is frequently observed as well.(40) Among elderly patients with normal EF and high pulmonary artery pressure, HFpEF may be the most common aetiology.”
Pathological Ventricular Remodeling: Mechanisms: Part 1 of 2 (2013, background): “Pulmonary hypertension is also associated with HFpEF, and elevated pulmonary artery pressures predict mortality in HFpEF patients.(14) Whether HFrEF and HFpEF are truly distinct disorders or rather represent a syndrome that exists across a spectrum is unknown.”
How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). (2019, background): “A PASP >35 mmHg discriminates HFpEF from hypertensives and controls.(207) A TR peak velocity >2.”
Epidemiology of Heart Failure (2013, background): “Although pulmonary venous hypertension contributes to pulmonary arterial hypertension, it does not always fully account for its severity, suggesting that a superimposed component of pulmonary arterial hypertension also plays a role.(57) Finally, these mechanisms are not exclusive of one another, and”
Epidemiology and clinical course of heart failure with preserved ejection fraction (2011, background): “Further, increasing pulmonary artery systolic pressure was associated with increasing mortality in HFPEF.(33)”
Left ventricular heart failure and pulmonary hypertension (2015, background): “In HFpEF, studies demonstrated that the presence of PH was also strongly associated with mortality.(15) – 17 Furthermore, HFpEF patients commonly display RV dysfunction, which is associated with elevated PAP, occurs at more advanced stages, and represents a strong predictor of death.”