Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2017 Oct 7;38(38):2874-2878.
doi: 10.1093/eurheartj/ehx184.

Is it time to recognize a new phenotype? Heart failure with preserved ejection fraction with pulmonary vascular disease

Barry A Borlaug  1 , Masaru Obokata  1
Affiliations
Comment

Is it time to recognize a new phenotype? Heart failure with preserved ejection fraction with pulmonary vascular disease

Barry A Borlaug et al. Eur Heart J. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Haemodynamic tracings in two heart failure with preserved ejection fraction patients with pulmonary vascular disease (PVD). (A) Patient has advanced PVD, with severe elevation in pulmonary artery (PA) pressure (PAP, systolic/diastolic/mean, blue lines) that is caused by both high PA wedge pressure (PAWP, red) and elevated pulmonary vascular resistance (PVR). With exercise, both PAP and PAWP increase in tandem, and there is failure of PA vasodilation (no change in PVR) as flow (cardiac output, CO) increases. (B) Patient has less advanced PVD, and based upon resting haemodynamics alone, he would be categorized as mild Group 1 pulmonary hypertension, because PAWP is normal while PAP and PVR are elevated. However, with the stress of exercise, there is dramatic elevation in PAWP, but out of proportion increase in PAP as CO rises, such that PVR actually increases, indicating that both left heart disease and PVD are present. Black lines represent right atrial pressure.
Figure 2
Figure 2
The spectrum of pulmonary hypertension in normal ejection fraction. At the ends of the spectrum there are ‘pure’ pulmonary vascular disease (Group 1 PH, green) and ‘pure’ HFpEF with no PVD (red). In between, there may be patients with PVD and some element of occult HFpEF, e.g. if PCWP is normal due to diuresis or underfilling of the left atrium (light green). There are also patients with early HFpEF and abnormal pulmonary vasodilation that is restricted to exercise (dark orange), and others with both elevated PCWP and PVD at rest and during exercise (HFpEF-PVD, light orange). In this proposed algorithm the presence or absence of PVD is defined by PVR, but further research is required to determine if this is the best metric to make this distinction, or alternatives such as PA compliance and DPG might be superior. CTEPH, chronic thromboembolic pulmonary hypertension; EF, ejection fraction; Ex, exercise; HFpEF, heart failure with preserved ejection fraction; HOHF, high output heart failure; PAWP, pulmonary artery wedge pressure; PH, pulmonary hypertension; PVD, pulmonary vascular disease; PVR, pulmonary vascular resistance; VHD, valvular heart disease.
See this image and copyright information in PMC

Comment on

References

    1. Lam CS, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM.. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 2009;53:1119–1126. - PMC - PubMed
    1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J.. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016;37:67–119. - PubMed
    1. Melenovsky V, Andersen MJ, Andress K, Reddy YN, Borlaug BA.. Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications. Eur J Heart Fail 2015;17:1161–1171. - PubMed
    1. Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA.. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J 2014;35:3452–3462. - PMC - PubMed
    1. Mohammed SF, Hussain I, Abou Ezzeddine OF, Takahama H, Kwon SH, Forfia P, Roger VL, Redfield MM.. Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation 2014;130:2310–2320. - PMC - PubMed

Publication types

LinkOut - more resources