Clinical features do not identify risk of progression from isolated postcapillary pulmonary hypertension to combined pre- and postcapillary pulmonary hypertension.

Autor: Babu G; Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA., Annis JS; Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA., Garry JD; Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA., Freiberg MS; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Nashville Tennessee USA., Hemnes AR; Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Nashville Tennessee USA., Brittain EL; Department of Medicine, Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA.; Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Research Center Vanderbilt University Medical Center Nashville Tennessee USA.
Jazyk: angličtina
Zdroj: Pulmonary circulation [Pulm Circ] 2023 Jun 15; Vol. 13 (2), pp. e12249. Date of Electronic Publication: 2023 Jun 15 (Print Publication: 2023).
DOI: 10.1002/pul2.12249
Abstrakt: Pulmonary hypertension is a common sequelae of left heart failure and may present as isolated postcapillary pulmonary hypertension (Ipc-PH) or combined pre- and postcapillary pulmonary hypertension (Cpc-PH). Clinical features associated with progression from Ipc-PH to Cpc-PH have not yet been described. We extracted clinical data from patients who underwent right heart catheterizations (RHC) on two separate occasions. Ipc-PH was defined as mean pulmonary pressure >20 mmHg, pulmonary capillary wedge pressure >15 mmHg, and pulmonary vascular resistance (PVR) < 3 WU. Progression to Cpc-PH required an increase in PVR to ≥3 WU. We performed a retrospective cohort study with repeated assessments comparing subjects that progressed to Cpc-PH to subjects that remained with Ipc-PH. Of 153 patients with Ipc-PH at baseline who underwent a repeat RHC after a median of 0.7 years (IQR 0.2, 2.1), 33% (50/153) had developed Cpc-PH. In univariate analysis comparing the two groups at baseline, body mass index (BMI) and right atrial pressure were lower, while the prevalence of moderate or worse mitral regurgitation (MR) was higher among those who progressed. In age- and sex-adjusted multivariable analysis, only BMI (OR 0.94, 95% CI 0.90-0.99, p  = 0.017, C  = 0.655) and moderate or worse MR (OR 3.00, 95% CI 1.37-6.60, p  = 0.006, C  = 0.654) predicted progression, but with poor discriminatory power. This study suggests that clinical features alone cannot distinguish patients at risk for development of Cpc-PH and support the need for molecular and genetic studies to identify biomarkers of progression.
Competing Interests: Anna Hemnes serves as a consultant for United Therapeutics, Janssen, GossamerBio, and Merck. She holds stock in Tenax Therapeutics. The remaining authors declare no conflict of interest.
(© 2023 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
Databáze: MEDLINE
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