title: Diffusion Capacity and Mortality in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction.
abstract: This study sought to investigate the prognostic importance of a low diffusion capacity of the lung for carbon monoxide (DLCO) in patients with a catheter-based diagnosis of pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
  
  
  
  In patients with pulmonary arterial hypertension, a low DLCO is associated with poor outcome. It is unclear whether the same is true in patients with PH-HFpEF.
  
  
  
  This study retrospectively analyzed clinical characteristics, smoking history, lung function measurements, chest computed tomography, hemodynamics, and survival in 108 patients with PH-HFpEF. The presence of post-capillary PH was determined by right heart catheterization. Patients with moderate or severe lung function abnormalities were excluded.
  
  
  
  On the basis of previous studies and receiver-operating characteristic curve analysis, the study cohort was divided into patients with a DLCO <45% of the predicted value (DLCO<45%, low DLCO; n = 52) and patients with a DLCO ≥45% of the predicted value (DLCO≥45%; n = 56). DLCO<45% was associated with male sex (odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.05 to 6.99; p = 0.039) and smoking history (OR: 5.01; 95% CI: 1.91 to 13.10; p < 0.001). There were no correlations between DLCO and other lung function parameters and hemodynamics. Compared with patients with DLCO≥45%, patients with DLCO<45% had a significantly worse outcome (survival rate at 3 years 36.5% vs. 87.8%, p < 0.001 by log-rank analysis). Cox proportional hazard analysis identified DLCO<45% as an independent predictor of death (hazard ratio: 6.6; 95% CI: 2.6 to 16.9; p < 0.001).
  
  
  
  In patients with PH-HFpEF, a low DLCO is strongly associated with mortality.
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany. Electronic address: hoeper.marius@mh-hannover.de.
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Rademacher
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Fuge
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
mesh_terms: D000368:Aged; D002248:Carbon Monoxide; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D012189:Retrospective Studies; D013318:Stroke Volume
chemical_list: D002248:Carbon Monoxide
keywords: diffusion capacity; heart failure; hypertension; pulmonary; smoking; survival