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. 2025 Jul 22;25(1):348.
doi: 10.1186/s12890-025-03833-4.

Pulmonary arterial hypertension with cardiopulmonary comorbidities: is it a unique phenotype?

Meng Zhang #  1 , Xueran Guo #  1   2 , Wei Guo  1 , Yan Wang  1 , Yao Xiao  1 , Jiancheng Han  3 , Ye Li  3 , Tingting Man  3 , Jie Li  1 , Yong Chen  1 , Shengchen Duan  1 , Wenmei Zhang  1 , Hui Li  1 , Ao Yin  1 , Jiafei Peng  1 , Chunrong An  1 , Wanmu Xie  4 , Qian Gao  4 , Shuai Zhang  4 , Yunxia Zhang  4 , Zhenguo Zhai  4 , Jun Wan  5
Affiliations

Pulmonary arterial hypertension with cardiopulmonary comorbidities: is it a unique phenotype?

Meng Zhang et al. BMC Pulm Med. .

Abstract

Background: Pulmonary arterial hypertension (PAH) patients with cardiopulmonary comorbidities have been prevalent nowadays. However, there was limited data on clinical characteristics and therapeutic responses in these populations.

Methods: Patients diagnosed with right heart catheterization (RHC)-confirmed PAH between October 2021 to March 2023 were included in our study. According to whether they had cardiopulmonary diseases or not, they were classified into two groups: comorbidities group and non-comorbidities group. We aimed to compare the clinical data, PAH-targeted strategies, and therapeutic responses between these two PAH groups. We further analyzed the impact of the numbers and categories of comorbidities on therapeutic responses.

Results: Almost half of the patients co-existed with cardiopulmonary diseases. Compared with non-comorbidities group (n = 40), comorbidities group (n = 36) were senior (p = 0.000) and male predominantly (p = 0.005). Comorbidities group also associated inconsistencies between hemodynamics and 6-min walking distance (6MWD), with a shorter 6MWD (p = 0.000), but a lower mean pulmonary artery pressure (mPAP) (p = 0.008). Non-comorbidities group showed an upturn in the WHO-FC (p = 0.010) and risk assessment (p = 0.033), while the improvement of hemodynamics [decreased mPAP (p = 0.009) and pulmonary vascular resistance (PVR) (p = 0.001), increased cardiac index (p = 0.001)] in comorbidities group did not match the change in clinical severity (no significant improvements in WHO-FC, risk stratification and 6MWD). When categorized by the comorbidities counts, it demonstrated that the more comorbidities, the more severe the clinical conditions, and the worse the therapeutic responses.

Conclusion: PAH patients with cardiopulmonary comorbidities represent a unique phenotype, with different clinical manifestation and treatment responses from typical PAH and inconsistencies between hemodynamics and functional status from baseline to follow-up.

Keywords: Clinical characteristics; Comorbidity; Pulmonary arterial hypertension (PAH); Therapeutic responses.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Informed consent of all participants was obtained for participation in the study. This study was approved by the Medical Ethics Committee of Beijing Anzhen Hospital Affiliated to Capital Medical University (KS2022037). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram. PAH, pulmonary arterial hypertension; PH, pulmonary hypertension; RHC, right heart catheterization
Fig. 2
Fig. 2
Distribution of cardiovascular and pulmonary comorbidities. A We analyzed the disease distribution in all of the cardiovascular populations included in the cardiovascular and cardiopulmonary groups. B We analyzed the distribution in all of the pulmonary comorbidities included in the pulmonary and cardiopulmonary groups. COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease; OSAHS, obstructive sleep apnea–hypopnea syndrome
See this image and copyright information in PMC

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