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Published on: March 1, 2022
Post-capillary pulmonary hypertension in heart failure: impact of current definition in the PH-HF multicentre study
Charles Fauvel1,2,3, Thibaud Damy4, Emmanuelle Berthelot5,6
1Cardiology Department, Rouen University Hospital, F-76000 Rouen, France.
Insights
The new 2022 European guidelines for post-capillary pulmonary hypertension (pcPH) in heart failure (HF) increase prevalence and identify combined pcPH (CpcPH) as a worse prognostic indicator. Elevated mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) predict outcomes.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Heart Failure Research
Background:
- The 2022 European guidelines revised post-capillary pulmonary hypertension (pcPH) definitions in heart failure (HF) by lowering mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) thresholds.
- The clinical impact and prognostic value of these revised pcPH definitions have not been prospectively evaluated.
Purpose of the Study:
- To prospectively evaluate the impact of the successive pcPH definitions on pcPH prevalence and its subgroups (isolated vs. combined pcPH) in stable left HF patients.
- To assess the prognostic value of mPAP and PVR on all-cause death or HF hospitalization using multivariable Cox regression analysis.
Main Methods:
- A multicentre study enrolled 662 stable left HF patients requiring right heart catheterization between 2010 and 2018.
- Patients were prospectively followed up to evaluate the impact of successive pcPH definitions on prevalence and subgroup analysis (IpcPH vs. CpcPH).
- Multivariable Cox regression was used to determine the prognostic significance of mPAP and PVR for the primary outcome (all-cause death or HF hospitalization).
Main Results:
- Lowering mPAP from 25 to 20 mmHg increased pcPH prevalence by 10%; lowering PVR from 3 to 2 WU increased combined pcPH (CpcPH) prevalence by 60%, showing significant net reclassification improvement.
- Both mPAP and PVR remained significant predictors of the primary outcome (HR 1.02, P=.01 for mPAP; HR 1.07, P=.03 for PVR).
- The optimal PVR threshold for predicting the primary outcome was approximately 2.2 WU. Patients classified with pcPH using the 2022 definition had worse survival, with CpcPH showing significantly worse outcomes than isolated pcPH (IpcPH).
Conclusions:
- This study is the first to highlight the impact of the new pcPH definition on CpcPH prevalence in HF patients.
- The findings validate the prognostic value of mPAP > 20 mmHg and PVR > 2 WU for predicting adverse outcomes in HF patients.
- The revised definition and identified thresholds are crucial for risk stratification and management of HF patients with pulmonary hypertension.
Background And Aims:
Based on retrospective studies, the 2022 European guidelines changed the definition of post-capillary pulmonary hypertension (pcPH) in heart failure (HF) by lowering the level of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). However, the impact of this definition and its prognostic value has never been evaluated prospectively.
Methods:
Stable left HF patients with the need for right heart catheterization were enrolled from 2010 to 2018 and prospectively followed up in this multicentre study. The impact of the successive pcPH definitions on pcPH prevalence and subgroup [i.e. isolated (IpcPH) vs. combined pcPH (CpcPH)] was evaluated. Multivariable Cox regression analysis was used to assess the prognostic value of mPAP and PVR on all-cause death or hospitalization for HF (primary outcome).
Results:
Included were 662 HF patients were (median age 63 years, 60% male). Lowering mPAP from 25 to 20 mmHg resulted in +10% increase in pcPH prevalence, whereas lowering PVR from 3 to 2 resulted in +60% increase in CpcPH prevalence (with significant net reclassification improvement for the primary outcome). In multivariable analysis, both mPAP and PVR remained associated with the primary outcome [hazard ratio (HR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = .01; HR 1.07, 95% CI 1.00-1.14, P = .03]. The best PVR threshold associated with the primary outcome was around 2.2 WU. Using the 2022 definition, pcPH patients had worse survival compared with HF patients without pcPH (log-rank, P = .02) as well as CpcPH compared with IpcPH (log-rank, P = .003).
Conclusions:
This study is the first emphasizing the impact of the new pcPH definition on CpcPH prevalence and validating the prognostic value of mPAP > 20 mmHg and PVR > 2 WU among HF patients.
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