title: Interaction between pulmonary hypertension and diastolic dysfunction in an elderly heart failure population.
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.
  
  
  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.
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: vanessa.van.empel@mumc.nl.
authors.forename: Vanessa P M
authors.initials: VP
authors.lastname: van Empel
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Beat A
authors.initials: BA
authors.lastname: Kaufmann
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland; Division of Cardiology, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bernheim
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland; Division of Cardiology, Leuven, Belgium.
authors.forename: Kaatje
authors.initials: K
authors.lastname: Goetschalckx
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Son Y
authors.initials: SY
authors.lastname: Min
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Muzzarelli
authors.affiliation: Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.affiliation: Division of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kiencke
authors.affiliation: Division of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands; Division of Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D014463:Ultrasonography
keywords: Heart failure; diastole; diastolic dysfunction; pulmonary hypertension