Interaction Between Pulmonary Hypertension and Diastolic Dysfunction in an Elderly Heart Failure Population

Vanessa P. M. Van Empel*, Beat A. Kaufmann, Alain M. Bernheim, Kaatje Goetschalckx, Son Y. Min, Stefano Muzzarelli, Matthias E. Pfisterer, Stephanie Kiencke, Micha T. Maeder, Hans-Peter Brunner-La Rocca

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    6 Citations (Web of Science)

    Abstract

    Background: Pulmonary hypertension due to left heart disease is very common. Our aim was to investigate the relationship of the severity of left ventricular diastolic dysfunction with precapillary and postcapillary pulmonary hypertension (PH) in an elderly heart failure (HF) population. Methods and Results: A post hoc analysis of the Trial of Intensified Medical Therapy in Elderly Patients With Congestive Heart Failure data was done. Baseline transthoracic echocardiography was used to categorize diastolic function, estimate pulmonary artery pressure and pulmonary capillary wedge pressure, and calculate the transpulmonary pressure gradient (TPG). Among 392 HF patients, PH was present in 31% of patients with grade 1, in 37% of patients with grade 2, and in 65% of patients with grade 3 diastolic dysfunction; 54% of all HF patients with PH had a TPG >12 mm Hg, suggesting not only a postcapillary but also an additional precapillary component of PH. Survival was not related to the severity of diastolic dysfunction, but was worse in patients with PH (hazard ratio 1.63, 95% confidence interval 1.07-2.51; P = .024). Conclusions: Our data indicate that HF patients with even mild diastolic dysfunction often have PH. Echocardiographic assessment suggest that the presence of PH might not simply be due to increased PCWP, but in part due to a precapillary component.
    Original languageEnglish
    Pages (from-to)98-104
    JournalJournal of Cardiac Failure
    Volume20
    Issue number2
    DOIs
    Publication statusPublished - Feb 2014

    Keywords

    • Heart failure
    • diastole
    • diastolic dysfunction
    • pulmonary hypertension

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