Clinical significance of reactive post-capillary pulmonary hypertension in patients with left heart disease.
BACKGROUND
Post-capillary pulmonary hypertension (pc-PH) is a disorder with elevated pulmonary arterial pressure and pulmonary vascular resistance (PVR) because of left heart disease (LHD), and is classified as reactive (PVR >2.5 WU) or passive (PVR ≤ 2.5 WU). However, the clinical significance of these pc-PH subtypes remains to be elucidated.


RESULTS
We examined 676 consecutive patients with chronic heart failure (CHF) (NYHA ≥ 2), and found that 158 (23%) had pc-PH: reactive pc-PH in 58 and passive pc-PH in 100. Univariate analysis showed that 4 factors were significantly associated with reactive pc-PH and multivariate analysis showed that female sex was the only independent predictor of reactive pc-PH (odds ratio 2.12, 95% confidence interval (CI) 1.05-4.30, P=0.03). During the mean follow-up period of 2.6 years, 125 CHF patients (18%) died, including 22 with reactive pc-PH and 24 with passive pc-PH (P<0.001). Multivariate Cox regression analysis showed that elevated PVR was independently associated with higher mortality (hazard ratio 1.18, 95%CI 1.03-1.35, P=0.02). Kaplan-Meier analysis demonstrated that the prognosis of patients with reactive pc-PH was significantly worse than for those with no PH or passive pc-PH. Reactive pc-PH was a significant prognostic factor regardless of CHF etiology (ischemic vs. non-ischemic) or reduced/preserved LV ejection fraction (HFrEF vs. HFpEF).


CONCLUSIONS
Reactive pc-PH is characterized by predominant female sex and is a significant prognostic factor of LHD with PH.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Shunsuke
S
Tatebe
Yoshihiro
Y
Fukumoto
Koichiro
K
Sugimura
Saori
S
Miyamichi-Yamamoto
Tatsuo
T
Aoki
Yutaka
Y
Miura
Kotaro
K
Nochioka
Kimio
K
Satoh
Hiroaki
H
Shimokawa
D000368:Aged; D001794:Blood Pressure; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D015996:Survival Rate; D014655:Vascular Resistance