title: Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction.
abstract: BACKGROUND
  Pulmonary vascular disease associated with left-side heart failure and preserved ejection fraction (PH-HFpEF) is an increasingly common cause of pulmonary hypertension. The distinction between PH-HFpEF and pulmonary arterial hypertension (PAH) is important because therapies indicated for PAH can be detrimental in HFpEF. The characteristic features of PH-HFpEF are understudied.
  
  
  RESULTS
  In a cross-sectional study, we compared the clinical, echocardiographic, and hemodynamic features of PH-HFpEF (n=100), with PAH (n=522), and HFpEF without pulmonary vascular disease (n=45). We determined the clinical characteristics that best differentiated PH-HFpEF from PAH. Compared with patients with PAH, patients with PH-HFpEF were older; had a higher prevalence of cardiovascular comorbidities; had worse exercise capacity and renal function; more frequently had left atrial enlargement; and less frequently had right atrial enlargement. PH was less severe in PH-HFpEF patients than in PAH patients (pulmonary vascular resistance 4.8 [interquartile range 3 to 8.4] versus 10.9 [interquartile range 7.4 to 15.7] Wood units; P<0.001). Old age, the presence of hypertension and coronary artery disease, the absence of right atrial enlargement, higher aortic systolic pressure, higher mean right atrial pressure, and higher cardiac output best differentiated PH-HFpEF from PAH (area under the receiver operating characteristics curve; curve 0.97). Compared with HFpEF patients without pulmonary hypertension, PH-HFpEF patients were often female and more symptomatic, more often had right ventricular hypertrophy and right atrial enlargement, and had higher right atrial pressure.
  
  
  CONCLUSIONS
  These data should help better identify PH-HFpEF, an entity that has become increasingly recognized and difficult to treat.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago, IL, USA.
authors.forename: Thenappan
authors.initials: T
authors.lastname: Thenappan
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.forename: Brett
authors.initials: B
authors.lastname: Collander
authors.forename: Ajay
authors.initials: A
authors.lastname: Vallakati
authors.forename: Pranavkumar
authors.initials: P
authors.lastname: Shroff
authors.forename: Stuart
authors.initials: S
authors.lastname: Rich
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume