Background
Pulmonary hypertension (PH) is a common complication of end-stage heart failure (ESHF)
and associated with increased mortality. The definition of PH has recently been changed
from a mean pulmonary arterial pressure (PAPm) ≥25 mmHg to a PAPm >20 mmHg. Since
this change, there are no data evaluating group 2 PH subgroups on outcomes. The purpose
of this study was to determine the impact of updated group 2 PH subgroups on outcomes,
as well as to evaluate the clinical, echocardiographic, and haemodynamic characteristics
of subgroups, and determine predictors of PH in patients with ESHF.
Method
A total of 416 patients with ESHF with left ventricular ejection fraction (LVEF) ≤25%
were divided into three groups. Pulmonary hypertension was defined as PAPm >20 mmHg.
Primary outcome was defined as left ventricular assist device (LVAD) implantation,
urgent heart transplantation (HT), or death. Secondary outcome was defined as LVAD
implantation and HT.
Results
Over a median follow-up of 503.5 days, combined pre- and postcapillary PH (Cpc-PH)
displayed greater risk of primary outcome than those with isolated postcapillary (Ipc-PH)
(hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.29–1.91; p<0.001) and those
with no PH (HR, 2.47; 95% CI, 1.68–3.63; p<0.001). Patients with Ipc-PH demonstrated
greater risk than those with no PH (HR, 1.57; 95% CI, 1.57–1.90; p<0.001). Likelihood
ratios of updated PH criteria and old PH criteria (PAPm ≥25 mmHg) in identifying primary
outcome were 75.6 (R2=0.179) and 72.09 (R2=0.164). Patients with PAPm 21–24 mmHg had a higher primary outcome than those with
PAPm ≤20 mmHg. Severe mitral regurgitation, LVEF, grade 3 diastolic dysfunction, diabetes,
and cardiac output were predictors of PH.
Conclusions
Pulmonary hypertension increases the risk of LVAD, urgent HT, or death, and Cpc-PH
further increases risk in patients with ESHF. Compared to the previous definition,
a new PH definition better discriminates death, going to urgent HT, or LVAD implantation
for PH subgroups.
Keywords
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Article info
Publication history
Published online: October 27, 2021
Accepted:
October 3,
2021
Received in revised form:
August 24,
2021
Received:
April 10,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
