The impact of left ventricular ejection fraction on heart failure patients with pulmonary hypertension

Barak Zafrir, Shemy Carasso, Sorel Goland, Liaz Zilberman, Robert Klempfner, Nir Shlomo, Evgeny Radzishevsky, Tal Hasin, Avraham Shotan, Alicia Vazan, Jean Marc Weinstein, Wadi Kinany, Robert Dragu, Elad Maor, Liza Grosman-Rimon, Offer Amir*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: The most common cause of pulmonary hypertension (PH) in developed countries is left heart disease (LHD, group 2 PH). The development of PH in heart failure (HF) patients is indicative of worse outcomes. Objective: The aim of this study was to evaluate the long term outcomes of HF patients with PH in a national long-term registry. Methods: Study included 9 cardiology centers across Israel between 01/2013–01/2015, with a 12-month clinical follow-up and 24-month mortality follow-up. Patients were age ≥18 years old with HF and pre-inclusion PH due to left heart disease determined by echocardiography [estimated systolic pulmonary arterial pressure (SPAP) ≥ 50 mmHg]. Patients were categorized into 3 groups: HF with reduced (HFrEF < 40%), mid-range (HFmrEF 40–49%), and preserved (HFpEF ≥ 50%) ejection fraction. Results: The registry included 372 patients, with high prevalence of cardiovascular risk factors. Median HF duration was 4 years and 65% were in severe HF New York Heart Association (NYHA) classification ≥3. Mean systolic pulmonary artery pressure (SPAP) was 62 ± 11 mmHg. During 2-years of follow-up, 54 patients (15%) died. Univariable predictors of mortality included NYHA grade 3–4, chronic renal failure, and SPAP ≥ 65 mmHg. Severe PH was associated with mortality in HFpEF, but not HFmrEF or HFrEF, and remained significant after multivariable adjustment with an adjusted hazard ratio of 2.99, (95%CI 1.29–6.91, p = 0.010). Conclusions: The combination of HFpEF with severe PH was independently associated with increased mortality. Currently, HFpEF patients are included with group 2 PH patients. Defining HFpEF with severe PH as a sub-class may be more appropriate, as these patients are at increased risk and deserve special consideration.

Original languageEnglish
Pages (from-to)502-506
Number of pages5
JournalHeart and Lung
Volume48
Issue number6
DOIs
StatePublished - 1 Nov 2019

Keywords

  • Heart failure
  • Mortality
  • Pulmonary hypertension

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