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. 2021 Mar 2;16(3):e0247987.
doi: 10.1371/journal.pone.0247987. eCollection 2021.

Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure

Tatsuro Ibe  1 , Hiroshi Wada  1 , Kenichi Sakakura  1 , Yusuke Ugata  1 , Hisataka Maki  1 , Kei Yamamoto  1 , Masaru Seguchi  1 , Yousuke Taniguchi  1 , Hiroyuki Jinnouchi  1 , Shin-Ichi Momomura  1 , Hideo Fujita  1
Affiliations

Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure

Tatsuro Ibe et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Wada has received speaking honoraria from Actelion Pharmaceuticals Japan Ltd., Nippon Shinyaku Co., Ltd., Bayer Yakuhin Ltd., and Pfizer Japan Inc. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Patient enrollment.
Ipc-PH, isolated post-capillary pulmonary hypertension; Cpc-PH, combined pre- and post-capillary pulmonary hypertension; PH, pulmonary hypertension; mPAP, mean pulmonary artery pressure, PAWP, pulmonary artery wedge pressure, PVR, pulmonary vascular resistance; WU, Wood units.
Fig 2
Fig 2. Kaplan-Meier curves for primary endpoint in the four groups.
Comparison of the survival curves was performed using the log-rank test. PH, pulmonary hypertension; Ipc-PH, isolated post-capillary pulmonary hypertension; Cpc-PH, combined pre- and post-capillary pulmonary hypertension.
See this image and copyright information in PMC

References

    1. Vachiery JL, Adir Y, Barbera JA, Champion H, Coghlan JG, Cottin V, et al.. Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol. 2013;62(25 Suppl):D100–8. 10.1016/j.jacc.2013.10.033 - DOI - PubMed
    1. Fang JC, DeMarco T, Givertz MM, Borlaug BA, Lewis GD, Rame JE, et al.. World Health Organization Pulmonary Hypertension group 2: pulmonary hypertension due to left heart disease in the adult—a summary statement from the Pulmonary Hypertension Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2012;31(9):913–33. 10.1016/j.healun.2012.06.002 - DOI - PubMed
    1. Kjaergaard J, Akkan D, Iversen KK, Kjoller E, Kober L, Torp-Pedersen C, et al.. Prognostic importance of pulmonary hypertension in patients with heart failure. Am J Cardiol. 2007;99(8):1146–50. 10.1016/j.amjcard.2006.11.052 - DOI - PubMed
    1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al.. 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 Respir J. 2015;46(4):903–75. 10.1183/13993003.01032-2015 - DOI - PubMed
    1. Miller WL, Grill DE, Borlaug BA. Clinical features, hemodynamics, and outcomes of pulmonary hypertension due to chronic heart failure with reduced ejection fraction: pulmonary hypertension and heart failure. JACC Heart Fail. 2013;1(4):290–9. 10.1016/j.jchf.2013.05.001 - DOI - PubMed