Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction
Abstract
BACKGROUND: Pulmonary vascular disease associated with left-side heart failure and preserved ejection fraction (PH-HFpEF) is an increasingly common cause of pulmonary hypertension. The distinction between PH-HFpEF and pulmonary arterial hypertension (PAH) is important because therapies indicated for PAH can be detrimental in HFpEF. The characteristic features of PH-HFpEF are understudied. METHODS AND RESULTS: In a cross-sectional study, we compared the clinical, echocardiographic, and hemodynamic features of PH-HFpEF (n=100), with PAH (n=522), and HFpEF without pulmonary vascular disease (n=45). We determined the clinical characteristics that best differentiated PH-HFpEF from PAH. Compared with patients with PAH, patients with PH-HFpEF were older; had a higher prevalence of cardiovascular comorbidities; had worse exercise capacity and renal function; more frequently had left atrial enlargement; and less frequently had right atrial enlargement. PH was less severe in PH-HFpEF patients than in PAH patients (pulmonary vascular resistance 4.8 [interquartile range 3 to 8.4] versus 10.9 [interquartile range 7.4 to 15.7] Wood units; P<0.001). Old age, the presence of hypertension and coronary artery disease, the absence of right atrial enlargement, higher aortic systolic pressure, higher mean right atrial pressure, and higher cardiac output best differentiated PH-HFpEF from PAH (area under the receiver operating characteristics curve; curve 0.97). Compared with HFpEF patients without pulmonary hypertension, PH-HFpEF patients were often female and more symptomatic, more often had right ventricular hypertrophy and right atrial enlargement, and had higher right atrial pressure. CONCLUSIONS: These data should help better identify PH-HFpEF, an entity that has become increasingly recognized and difficult to treat.
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Many patients with PH share a common link to the metabolic syndrome.
“Despite the diversity of patients who develop PH, many share a common link to the metabolic syndrome[4,12–14].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [13]
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- Authors
- Thenappan, T., Shah, S. J., Gomberg-Maitland, M., Collander, B., Vallakati, A., Shroff, P., & Rich, S.
- Affiliations
- Northwestern University (US)
- From the Section of Cardiology (T.T., M.G.M., S.R.), Department of Medicine, University of Chicago, Chicago, IL and the Division of Cardiology (S.S., B.C., A.V., P.S.), Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
- Venue
- Circulation Heart Failure
- Published
- 2011-05
- Volume
- 4
- Issue
- 3
- Pages
- 257-265
- ISSN
- 1941-3289 (ISSN-L)
- 1941-3297
- OpenAlex
- W2120117348
- Cited by
- 289
- References
- 37
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 11 · 2023: 13 · 2022: 14 · 2021: 23 · 2020: 17 · 2019: 12 · 2018: 18 · 2017: 30 · 2016: 34 · 2015: 31 · 2014: 25 · 2013: 22 · 2012: 20
- FWCI
- 20.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- pulmonary hypertension, heart failure with preserved ejection fraction, pulmonary vascular disease, pulmonary arterial hypertension, differential diagnosis, pulmonary vascular resistance, right atrial pressure, right ventricular hypertrophy, left atrial enlargement, exercise capacity, renal function, cardiovascular comorbidity, echocardiographic features
- MeSH terms
- Aged, Cross-Sectional Studies, Female, Heart Failure, Humans, Hypertension, Pulmonary, Male, Middle Aged, Stroke Volume
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