Pre-capillary pulmonary hypertension common in severe heart failure

By Eleanor McDermid, Senior medwireNews Reporter

Pulmonary hypertension (PH) is common in patients with heart failure (HF) and is likely to include a pre-capillary component, research suggests.

In a post-hoc analysis, PH was present in 45% of the 392 patients who participated in the Trial of Intensified Medical Therapy in Elderly patients with Congestive Heart Failure (TIME-CHF), report Vanessa van Empel (Maastricht University Medical Center, the Netherlands) and team.

The presence of PH was determined noninvasively with using Doppler echocardiography, and defined as a tricuspid regurgitation velocity greater than 2.9 m/s. It was associated with diastolic dysfunction, being present in 31% of patients with grade 1 diastolic dysfunction, 37% of those with grade 2, and 65% of those with grade 3.

The same pattern was observed when patients were divided into those with and without a preserved ejection fraction. The rate of PH did not differ between these groups, although the researchers note that they cannot be sure of this without invasive tests.

“Still, this is in keeping with earlier data suggesting PH is not related to systolic function, but may be significantly influenced by diastolic function,” they observe.

Among the patients with PH, 54% had an elevated transpulmonary gradient pressure, at a median of 12.5 mmHg.

This indicates that PH “might be not simply due to increased left-sided filling pressure, but in part due to an active, pre-capillary component”, the researchers write in the Journal of Cardiac Failure.

They add: “Remodelling of the pulmonary capillaries, such as medial hypertrophy and muscularization, has been shown to play a role in patients with long-standing PH due to chronic HF.”

PH was associated with patient outcomes, with those with PH a significant 63% more likely to die during 18 months of follow-up than those without. By contrast, the severity of diastolic dysfunction did not influence survival.

“The presence of PH in HF patients gives rise to the question whether specific therapies for PH could be beneficial,” say the researchers.

They say that previous trials that found no benefit with specific PH drugs involved unselected HF patients, which would dilute the effects of a treatment that mainly benefitted those with comorbid PH. Research in selected patient groups is therefore worth pursuing, they say.

“Our data indicate that a significant proportion of HF patients might profit from such therapy if proven to be beneficial,” conclude van Empel et al.

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