Researchers of a new study in Circulation: Heart
Failure have reported differences in characteristics between pulmonary
hypertension associated with left-sided HF and preserved ejection fraction and
pulmonary arterial hypertension, including less severe pulmonary hypertension
and a higher prevalence of CV comorbidities.
In the study, investigators enrolled three groups of
patients — those with pulmonary hypertension associated with left-sided HF
and preserved ejection fraction (PH-HFpEF; n=100), those with pulmonary
arterial hypertension (n=522) and those with HFpEF but without pulmonary
vascular disease (n=45). They then compared clinical, echocardiographic and
hemodynamic characteristics of the three groups to distinguish clinically
relevant differences in patients with PH-HFpEF.
Compared with patients with PAH, those with PH-HFpEF were found to have less severe
pulmonary hypertension (P<.001). Specifically, those with PH-HFpEF
vs. PAH were older and had an increased likelihood of CV comorbidities, worse
exercise capacity and
renal function, and left atrial enlargement, and they also
had a lesser likelihood of right atrial enlargement.
When compared with patients with HFpEF but without
pulmonary vascular disease, however, individuals with PH-HFpEF were more often
female and symptomatic, had higher right atrial pressure, and had a higher
likelihood of right atrial enlargement and right ventricular hypertrophy.
For future research, the researchers wrote:
“Studies to determine why some patients with HFpEF develop pulmonary
vascular disease while others do not are needed to better understand the
pathophysiology of PH-HFpEF. Because of the increasing frequency in which these
patients are becoming diagnosed, a better understanding of their outcome and
response to treatments is urgently needed.”