title: Combined Post- and Precapillary Pulmonary Hypertension in Patients With Heart Failure.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is a well-recognized complication of left ventricular heart failure (HF).
  
  
  OBJECTIVE
  Differences exist in demographic, clinical, hemodynamic, and survival characteristics of patients with left ventricular HF who have combined postcapillary and precapillary PH (CpcPH), isolated postcapillary PH, or no PH.
  
  
  METHODS
  A secondary data analysis was conducted using a large prospective database of patients undergoing right heart catheterization from 1994 to 2012. One-year mortality postcatheterization was assessed between PH groups using Kaplan-Meier and log-rank techniques, as well as a multivariate Cox proportional hazards model adjusted for age, sex, diabetes, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease. Mortality rates were calculated for each group as deaths per 100 person-years.
  
  
  RESULTS
  Of the 724 patients identified, 29.4% (n = 213) had no evidence of PH, 63.1% (n = 457) had isolated postcapillary PH, and 7.5% (n = 54) had CpcPH. Compared with no PH, there was an increased mortality rate within 1 year for CpcPH patients (crude hazard ratio: 5.22, 95% confidence interval: 2.06-13.22), but not for isolated postcapillary PH patients (crude hazard ratio: 2.12, 95% confidence interval: 0.99-4.57). Adjusted analyses revealed similar results. Mortality rates per 100 person-years were 3.9, 8.4, and 21.0 for no PH, isolated postcapillary PH, and CpcPH patients, respectively.
  
  
  CONCLUSIONS
  Heart failure patients with CpcPH are associated with increased death rate 1 year post-cardiac catheterization, compared with patients without PH. They are a high-risk PH group and should be evaluated and diagnosed earlier in the disease state.
authors: Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.
authors: Michael E
authors: ME
authors: Rezaee
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.
authors: Elizabeth L
authors: EL
authors: Nichols
authors: Division of Cardiology, Albany Medical Center, Albany, New York.
authors: Mandeep
authors: M
authors: Sidhu
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire.|Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.|Department of Community and Family Medicine, Lebanon, New Hampshire.
authors: Jeremiah R
authors: JR
authors: Brown
mesh_terms: D000368:Aged; D001794:Blood Pressure; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009513:New Hampshire; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: Epidemiology; Heart failure/cardiac transplantation/cardiomyopathy/myocarditis; Pulmonary hypertension