Abstract 13215: Clinical Features Do Not Identify Risk of Progression From Isolated Post-Capillary Pulmonary Hypertension to Combined Pre- and Post-Capillary Pulmonary Hypertension

Abstract

Introduction: Pulmonary hypertension (PH) is a common sequelae of left heart failure and is designated as either isolated post-capillary pulmonary hypertension (Ipc-PH) or combined pre- and post-capillary pulmonary hypertension (Cpc-PH). Clinical features associated with progression from Ipc-PH to Cpc-PH have not been described. Hypothesis: We hypothesized that clinical features do not distinguish patients who progress from Ipc-PH to Cpc-PH. Methods: We extracted hemodynamic and clinical data from patients referred for right heart catheterization (RHC) at least two times within 5 years. Ipc-PH was defined as mean pulmonary pressure ≥ 25 mmHg, wedge > 15 mmHg and pulmonary vascular resistance (PVR) < 3 WU. Progression to Cpc-PH required an increase in PVR to > 3 WU at the subsequent RHC. Comparisons made using the Mann-Whitney U and paired T-tests, and logistic regression adjusted for age and sex. Results: We identified 157 patients with Ipc-PH at baseline who underwent a repeat RHC after a median of 0.7 years (IQR 0.2, 2.1). The prevalence of Cpc-PH at the second RHC was 31% (49/157). The most common indication for repeat RHC referral was persistent heart failure symptoms (n = 107). Table 1 displays characteristics at the baseline RHC. BMI was lower and HDL higher among those who progressed. No other demographic, clinical, or laboratory features distinguished those who progressed either in univariate comparisons or after adjustment for age and sex. Of note, cardiac index was not significantly changed between baseline and repeat RHC (2.57 vs. 2.30 L/min/m2, p = 0.27) in those who progressed to Cpc-PH, indicating the increase in PVR was not driven by reduced right ventricular function. Conclusions: Clinical features alone cannot clearly distinguish patients at risk for progression from Ipc-PH to Cpc-PH. These findings support the need for molecular and genetic studies to identify risk factors for progression of pulmonary vascular disease in patients with heart failure.