Prevalence, characteristics and survival of pulmonary hypertension due to chronic heart failure: a national multicenter prospective registry study
Abstract Background The prevalence, characteristics and survival of pulmonary hypertension due to left heart disease (PH-LHD) in heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF) has yet to be explored. Methods Consecutive patients with chronic heart failure undergoing first right heart catheterization (RHC) were prospectively enrolled from October 2012 to August 2016 in 11 participating medical centers. Follow-up was performed every 6 months ± 2 weeks. The primary endpoint was all-cause mortality. Results A total of 500 patients were enrolled. The prevalence of PH was 67.2% in HFrEF and 40.2% in HFpEF, respectively. Predictors of PH differed between PH etiologies, but left ventricular end diastolic diameter (LVEDD) was a consistent both in HFrEF (P=0.031) and HFpEF (P=0.003). During a median follow-up time of 33.39 months, 69 patients (13.8%) met the primary endpoint. The survival of PH patients was significantly worse than that of patients without PH (P=0.001). Diastolic pressure gradient (DPG) was a significant prognostic variable both in HFrEF (HR=1.057, 95% CI=1.007-1.108, P=0.024) and HFpEF (HR=1.094, 95% CI=1.009-1.187, P=0.030). Patients with a DPG ≥ 7 mmHg had a worse survival compared to those whose DPG < 7 mmHg both in HFrEF (log rank test, P=0.047) and in HFpEF (P=0.016). Conclusion Though the prevalence, characteristics and prognosis of PH differ between HFrEF and HFpEF, PH-LHD is a common complication and has an adverse effect on the prognosis. Study registration NCT02164526.