Introduction: Predicting factors of outcomes in pulmonary hypertension due to left heart disease (PH-LHD) have not been fully investigated. We aim to explore the value of pulmonary hemodynamic parameters as prognostic indicators in pulmonary hypertension due to chronic heart failure with reduced ejection fraction (HFrEF).
Methods: We prospectively enrolled 135 patients with PH due to HFrEF, defined as mean pulmonary artery pressure (mPAP)≥25mmHg, pulmonary capillary wedge pressure (PCWP)>15mmHg at rest in right heart catheterization and left ventricular ejection fraction(LVEF)<40% in echocardiography. The combined endpoint of follow-up was death or transplantation.
Results: The average age of the study cohort was 49.7±13.8 years and 101(74.8%)of the patients were men. During a median follow up of 18.9(2.1,39.4)months, 72 patients reached the combined endpoint. The sum of pulmonary wedge pressure and right atrial pressure (PCWP+RAP) ≥35mmHg predicted worse survival rate compared with PCWP+RAP<35mmHg (39.1% VS 64.8%, Log-rank test: p=0.02). Multivariate COX analysis found that PCWP+RAP≥35mmHg (HR 2.025, 95%CI 1.214-3.378) and clinical parameters diastolic blood pressure(DBP)≤70mmHg (HR 1.804, 95%CI 1.057-3.079), total cholesterol<4mmol/L (HR 2.436, 95%CI 1.465-4.050), uric acid ≥500μmol/L (HR 1.958, 95%CI 1.097-3.493), NYHA class IV (HR 1.754, 95%CI 1.025-3.000) remained independent indicators of death or transplantation. The C-index of the overall survival model was 0.69. Diastolic pressure gradient (DPG) ≥7mmHg identified patients with high risk of death or cardiac transplantation on Kaplan-Meier analysis (Log-rank test: p=0.017) in our cohort, but it was not significant in the multiple COX regression model.
Conclusion: PAWP+RAP may be a simple index predicting worse outcomes in patients with PH due to HFrEF in clinical practice. The COX regression model needs further validation.