Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy

Abstract

Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32–0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.

A Predictive Model for Dilated Cardiomyopathy With Pulmonary Hypertension

“…Afterwards, given the passive backward transmission of elevated left-sided lling pressures, the pressure in the left atrium chronically increases, which in turn increases the pressure in the pulmonary veins and pulmonary arteries [1,14]. At this point before the irreversible remodelling of pulmonary vessels, the phase is likely to be reversible if the left heart haemodynamics are improved [4]. Therefore, if PH-DCM can be detected before this phase and treatment can be obtained in time, the patients' prognosis may be improved to a large extent.…”

“…At present, related studies have shown that over one in ve DCM patients has a high pulmonary hypertension (PH) risk, and the longer DCM lasts, the higher the likelihood of developing pulmonary hypertension because of the resulting chronic increase in pressure in the left atrium [4]. Pulmonary hypertension (PH) was de ned by the 2015 ESC/ERS Guidelines as an increase in mean pulmonary arterial pressure (PAPm) ≥ 25 mmHg at rest as measured haemodynamically via right heart catheterization (RHC) [5].…”

Grading right ventricular dysfunction in left ventricular disease using echocardiography: a proof of concept using a novel multiparameter strategy

“…The cut‐off values indicating RVD ( Figure , lower panel) were chosen from reference populations 17 . The cut‐off value for Doppler PASP > 40 mmHg was chosen because this threshold is known to identify patients with pulmonary artery mean pressure (PAMP) > 25 mmHg 18 and correspond to a threshold with increased risk for all‐cause death 19 . The grading of tricuspid regurgitation was based on the density and shape of the regurgitant jet, the colour Doppler jet area, and presence of systolic hepatic vein flow reversal 20 …”

A predictive model for dilated cardiomyopathy with pulmonary hypertension

“…3 At present, related studies have shown that over one in five DCM patients has a high pulmonary hypertension (PH) risk, and the longer DCM lasts, the higher the likelihood of developing PH because of the resulting chronic increase in pressure in the left atrium. 4 PH was defined by the 2015 European Society of Cardiology and the European Respiratory Society (ESC/ERS) Guidelines as an increase in mean pulmonary arterial pressure (PAPm) ≥ 25 mmHg at rest as measured haemodynamically via right heart catheterization (RHC). 5 Marked by a combination of constriction and remodelling within the pulmonary vasculature, PH is a complex and progressive condition that can be divided into five major categories based on the underlying cause and haemodynamic parameters: (1) pulmonary arterial hypertension (PAH), (2) PH due to left heart disease (LHD), (3) PH due to interstitial lung diseases and/or hypoxia, (4) chronic thromboembolic PH (CTEPH) and (5) PH with unclear and/or multifactorial origin.…”