title: Pulmonary Hypertension in Heart Failure. Epidemiology, Right Ventricular Function, and Survival.
abstract: BACKGROUND
  Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH).
  
  
  OBJECTIVE
  To investigate epidemiology, risk factors, right ventricular function, and outcomes in patients with chronic heart failure and Cpc-PH.
  
  
  METHODS
  The study population was identified from a retrospective chart review of a clinical database of 3,107 stable patients who underwent first diagnostic right heart catheterization and from a prospective cohort of 800 consecutive patients at a national university-affiliated tertiary center.
  
  
  RESULTS
  The retrospective cohort had 664 patients with systolic heart failure (SHF) and 399 patients with diastolic heart failure (DHF), 12% of whom were classified as Cpc-PH. The prospective cohort had 172 patients with SHF (14% Cpc-PH) and 219 patients with DHF (12% Cpc-PH). Chronic obstructive pulmonary disease (P = 0.034) and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (P = 0.015) predicted Cpc-PH in SHF. Younger age (P = 0.004), valvular heart disease (P = 0.046), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio predicted Cpc-PH in DHF (P = 0.016). Right ventricular-pulmonary vascular coupling was worse in Cpc-PH patients (end-systolic elastance to effective arterial elastance [Ees/Ea]: SHF: 1.05 ± 0.25; P = 0.002; DHF: 1.17 ± 0.27; P = 0.027) than in those with isolated post-capillary PH (Ees/Ea: SHF: 1.52 ± 0.51; DHF: 1.45 ± 0.29).
  
  
  CONCLUSIONS
  Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Mario
authors.identifier: http://orcid.org/0000-0003-3295-4565
authors.initials: M
authors.lastname: Gerges
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerges
authors.affiliation: 2 Division of Cardiology, Department of Internal Medicine, Ferrarotto Hospital, University of Catania, Catania, Italy; and.
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Pistritto
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Marie B
authors.initials: MB
authors.lastname: Lang
authors.affiliation: 3 Department of Pulmonary Medicine, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Pia
authors.initials: P
authors.lastname: Trip
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Jakowitsch
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Binder
authors.affiliation: 1 Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D003644:Death Certificates; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D011660:Pulmonary Heart Disease / Q000453:epidemiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology
keywords: heart failure; hemodynamics; pulmonary heart disease; pulmonary hypertension