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Interaction between pulmonary hypertension and diastolic dysfunction in an elderly heart failure population
Vanessa P M van Empel1, Beat A Kaufmann2, Alain M Bernheim3
1Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Journal of Cardiac Failure
|December 24, 2013
Summary
Left heart disease in elderly heart failure patients often causes pulmonary hypertension (PH). Echocardiography reveals PH may involve both postcapillary and precapillary components, impacting survival.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Geriatrics
Background:
- Pulmonary hypertension (PH) is a common complication of left heart disease.
- Left ventricular diastolic dysfunction (LVDD) is prevalent in elderly heart failure (HF) patients.
Purpose of the Study:
- To investigate the association between LVDD severity and PH in elderly HF patients.
- To differentiate between precapillary and postcapillary PH components.
Main Methods:
- Post hoc analysis of the Trial of Intensified Medical Therapy in Elderly Patients With Congestive Heart Failure.
- Transthoracic echocardiography to assess diastolic function, pulmonary artery pressure, pulmonary capillary wedge pressure, and transpulmonary pressure gradient (TPG).
Main Results:
- PH prevalence increased with LVDD grade (31% grade 1, 37% grade 2, 65% grade 3).
- 54% of HF patients with PH had a TPG >12 mm Hg, indicating a mixed precapillary and postcapillary etiology.
- PH was associated with worse survival (HR 1.63, P = .024), but LVDD severity was not.
Conclusions:
- Elderly HF patients with LVDD frequently develop PH.
- Echocardiographic findings suggest PH in this population may stem from a precapillary component, not solely elevated pulmonary capillary wedge pressure.
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