Cargando…
Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure
BACKGROUND: The prognostic implications of combined pre- and post-capillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension due to left heart disease (PH-LHD) remain controversial. The aim of this retrospective study was to evaluate the new PH-LHD criteria, recommended by the...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924774/ https://www.ncbi.nlm.nih.gov/pubmed/33651852 http://dx.doi.org/10.1371/journal.pone.0247987 |
_version_ | 1783659160709103616 |
---|---|
author | Ibe, Tatsuro Wada, Hiroshi Sakakura, Kenichi Ugata, Yusuke Maki, Hisataka Yamamoto, Kei Seguchi, Masaru Taniguchi, Yousuke Jinnouchi, Hiroyuki Momomura, Shin-ichi Fujita, Hideo |
author_facet | Ibe, Tatsuro Wada, Hiroshi Sakakura, Kenichi Ugata, Yusuke Maki, Hisataka Yamamoto, Kei Seguchi, Masaru Taniguchi, Yousuke Jinnouchi, Hiroyuki Momomura, Shin-ichi Fujita, Hideo |
author_sort | Ibe, Tatsuro |
collection | PubMed |
description | BACKGROUND: The prognostic implications of combined pre- and post-capillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension due to left heart disease (PH-LHD) remain controversial. The aim of this retrospective study was to evaluate the new PH-LHD criteria, recommended by the 6th World Symposium on Pulmonary Hypertension and to determine the prognostic value of Cpc-PH. METHODS: A total of 701 patients with symptomatic heart failure who had undergone right-heart catheterization were divided into the following four groups: (i) Isolated post-capillary PH (Ipc-PH) group; mean pulmonary artery pressure (mPAP) >20 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and pulmonary vascular resistance (PVR) <3 Wood units (WU) (ii) Cpc-PH group; mPAP >20 mmHg, PAWP >15 mmHg, and PVR ≥3 WU (iii) borderline-PH group; mPAP >20 mmHg and PAWP ≤15 mmHg (iv) non-PH group; mPAP ≤20 mmHg. Multivariate Cox hazard analysis was used to investigate whether Cpc-PH was associated with cardiac outcomes. RESULTS: The study subjects were allocated into the Ipc-PH (n = 268), Cpc-PH (n = 54), borderline-PH (n = 112), or non-PH (n = 267) groups. The Cpc-PH group was associated significantly with adverse cardiac events even after adjustment for clinically relevant confounding factors for heart failure prognosis (vs. non-PH group: HR 2.98 [95% CI 1.81–4.90], P <0.001; vs. Ipc-PH group: HR: 1.92 [95% CI 1.19–3.08], P = 0.007). CONCLUSIONS: The new definitions of PH-LHD stratified patients into 4 categories. Long-term clinical outcomes were significantly different between the four categories, with Cpc-PH having the worst cardiac outcomes. |
format | Online Article Text |
id | pubmed-7924774 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-79247742021-03-10 Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure Ibe, Tatsuro Wada, Hiroshi Sakakura, Kenichi Ugata, Yusuke Maki, Hisataka Yamamoto, Kei Seguchi, Masaru Taniguchi, Yousuke Jinnouchi, Hiroyuki Momomura, Shin-ichi Fujita, Hideo PLoS One Research Article BACKGROUND: The prognostic implications of combined pre- and post-capillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension due to left heart disease (PH-LHD) remain controversial. The aim of this retrospective study was to evaluate the new PH-LHD criteria, recommended by the 6th World Symposium on Pulmonary Hypertension and to determine the prognostic value of Cpc-PH. METHODS: A total of 701 patients with symptomatic heart failure who had undergone right-heart catheterization were divided into the following four groups: (i) Isolated post-capillary PH (Ipc-PH) group; mean pulmonary artery pressure (mPAP) >20 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and pulmonary vascular resistance (PVR) <3 Wood units (WU) (ii) Cpc-PH group; mPAP >20 mmHg, PAWP >15 mmHg, and PVR ≥3 WU (iii) borderline-PH group; mPAP >20 mmHg and PAWP ≤15 mmHg (iv) non-PH group; mPAP ≤20 mmHg. Multivariate Cox hazard analysis was used to investigate whether Cpc-PH was associated with cardiac outcomes. RESULTS: The study subjects were allocated into the Ipc-PH (n = 268), Cpc-PH (n = 54), borderline-PH (n = 112), or non-PH (n = 267) groups. The Cpc-PH group was associated significantly with adverse cardiac events even after adjustment for clinically relevant confounding factors for heart failure prognosis (vs. non-PH group: HR 2.98 [95% CI 1.81–4.90], P <0.001; vs. Ipc-PH group: HR: 1.92 [95% CI 1.19–3.08], P = 0.007). CONCLUSIONS: The new definitions of PH-LHD stratified patients into 4 categories. Long-term clinical outcomes were significantly different between the four categories, with Cpc-PH having the worst cardiac outcomes. Public Library of Science 2021-03-02 /pmc/articles/PMC7924774/ /pubmed/33651852 http://dx.doi.org/10.1371/journal.pone.0247987 Text en © 2021 Ibe et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Ibe, Tatsuro Wada, Hiroshi Sakakura, Kenichi Ugata, Yusuke Maki, Hisataka Yamamoto, Kei Seguchi, Masaru Taniguchi, Yousuke Jinnouchi, Hiroyuki Momomura, Shin-ichi Fujita, Hideo Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title | Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title_full | Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title_fullStr | Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title_full_unstemmed | Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title_short | Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure |
title_sort | combined pre- and post-capillary pulmonary hypertension: the clinical implications for patients with heart failure |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924774/ https://www.ncbi.nlm.nih.gov/pubmed/33651852 http://dx.doi.org/10.1371/journal.pone.0247987 |
work_keys_str_mv | AT ibetatsuro combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT wadahiroshi combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT sakakurakenichi combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT ugatayusuke combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT makihisataka combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT yamamotokei combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT seguchimasaru combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT taniguchiyousuke combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT jinnouchihiroyuki combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT momomurashinichi combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure AT fujitahideo combinedpreandpostcapillarypulmonaryhypertensiontheclinicalimplicationsforpatientswithheartfailure |