Risk assessment in pulmonary hypertension associated with heart failure and preserved ejection fraction

Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

“…15,16,[19][20][21] Nonetheless, persistence of some degree of PH after acute hospital admission drives a worse clinical outcome and may represent a basic target of treatment. 22 Compared with PH attributable to HFrEF more pathogeneses account for PH-HFpEF with a high prevalence of hypertensive heart disease, diabetes mellitus, and obesity.…”

“…6 Studies investigating the pattern of right heart function and geometry in PH-HFpEF are summarized in Table 1. [9][10][11]14,15,21,[40][41][42][43][44][45] In a report by Puwanant et al, 11 RV dysfunction, assessed by RV fractional area and tissue Doppler S prime, was not uncommon in patients with HFpEF although in a milder degree compared with HFrEF. Similar findings were reported by looking at RV global longitudinal early diastolic strain rate and systolic RV global longitudinal systolic strain.…”

“…40 The risk related to PH-HFpEF has been analyzed under a score format, 21 which was validated in 2 independent PH-HFpEF cohorts including a retrospective and a prospective systemic cohort. Several clinical characteristics emerged as relevant and independent predictors of all-cause death with 8 variables (NYHA class, diastolic blood pressure, pulmonary artery saturation, interstitial lung disease, hypotension, RV hypertrophy, DLCO, and creatinine) identified as combined prognosticators at multistep regression analysis.…”

Severely reduced diffusion capacity in idiopathic pulmonary arterial hypertension: patient characteristics and treatment responses

“…Left heart disease A severely reduced DLCO is found in ,25% of patients with PH due to left heart failure with preserved ejection fraction [5]. Therefore, a possible explanation for a severe reduction in DLCO in IPAH may be the presence of left heart failure.…”

“…The reduction in DLCO is moderate in the majority of patients and the presence of a severely reduced DLCO during the diagnostic work-up should raise suspicion of secondary causes of pulmonary hypertension, such as connective tissue disease [2,3], pulmonary venoocclusive disease [4], left heart failure [5], and parenchymal lung disease [6,7]. However, in a subgroup of patients no secondary causes explaining the low DLCO are found and patients are then classified as IPAH.…”