Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival

Abstract

Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.

Acute hemodynamic effects of inhaled sodium nitrite in pulmonary hypertension associated with heart failure with preserved ejection fraction

“…The exact definition of PH in the setting of left heart disease is still debated, but includes at least the criteria of a mean pulmonary artery pressure greater than or equal to 25 mmHg and a pulmonary capillary wedge pressure greater than or equal to 15 mmHg (10). Additional hemodynamic criteria of PH in the setting of left heart disease, along with how such criteria affect prevalence and outcomes, continue to be debated, with the ultimate goal to identify a phenotype amenable to specific targeted therapies (1,2,(10)(11)(12)(13)(14)(15).…”

The difficult diagnosis of pulmonary vascular disease in heart failure

“…This difference is not trivial. GERGES and co-workers [5,6] had previously shown that Cpc-PH as a complication of heart failure with or without preserved ejection fraction, or increased risk of pulmonary vascular disease in these patients is associated with more severe PH, worse functional class, more commonly altered right ventricular function and decreased survival, when compared with Ipc-PH.…”

“…This difference is not trivial. GERGES and co-workers [5,6] had previously shown that Cpc-PH as a complication of heart failure with or without preserved ejection fraction, or increased risk of pulmonary vascular disease in these patients is associated with more severe PH, worse functional class, more commonly altered right ventricular function and decreased survival, when compared with Ipc-PH.The debate about the best combination of measurements to predict morphological changes in the pulmonary circulation is not new. When COURNAND et al [7] reported in 1945 the first cardiac catheterisation of a patient, who happened to suffer from severe PH on mitral stenosis, the histopathology of this form of PH-LHD had already been extensively described [8].…”

“…The prevalence of Cpc-PH in PH-LHD is, fortunately, relatively low. In the experience of Gerges and co-workers, it would amount to 16% if defined by a combination of increased DPG and TPG [5] and to 14% if defined by a combination of increased DPG and PVR [1,6]. So-defined Cpc-PH may have a life expectancy comparable to that of untreated pulmonary arterial hypertension [5,6].…”

Baseline diastolic pressure gradient and pressure reduction in chronic heart failure patients implanted with the CardioMEMS™ HF sensor

“…Isolated post‐capillary PH (Ipc‐PH) represents a unique subset of those with PH and can be defined by a diastolic pulmonary gradient (DPG) <7 mmHg, while combined pre‐capillary and post‐capillary PH (Cpc‐PH) patients have a DPG ≥7 mmHg 3. More importantly, Cpc‐PH patients not only develop maladaptive pulmonary vascular remodelling but also have poorer right ventricular–pulmonary vascular coupling and worse clinical outcomes 1, 5, 7, 8, 9, 10…”