Abstract 14302: One-Year Survival in Heart Failure Patients With Preserved Ejection Fraction and Isolated Post-Capillary or Combined Post- and Pre-Capillary Pulmonary Hypertension

Abstract

Introduction: Patients with combined post- and pre-capillary pulmonary hypertension (CpcPH) or isolated post-capillary pulmonary hypertension (PH) have been understudied due to limited hemodynamic information from right heart catheterization (RHC), which is not routinely performed in heart failure patients. This study compared the characteristics and outcomes of stable heart failure patients with no PH, isolated PH, and CpcPH determined by diastolic pulmonary gradient. Hypothesis: We hypothesized CpcPH would have lower 1-year survival compared to no PH or isolated PH patients undergoing RHC. Methods: We used the Dartmouth Dynamic Registry to identify patients with heart failure and preserved ejection fraction that underwent RHC at Dartmouth Hitchcock Medical Center between 1994 and 2012. CpcPH was defined by a diastolic pulmonary gradient >7mmHg. We obtained mortality data from the National Death Index. We compared demographic, clinical, laboratory, and hemodynamic characteristics of patients with no PH, isolated PH, and CpcPH. We used Kaplan-Meier statistics and multivariable Cox proportional hazards models to compare hazard for 1-year mortality for patients with no PH, isolated PH, and CpcPH adjusted for age, sex, diabetes, chronic kidney disease, and atrial fibrillation. Results: We identified 724 patients, of which 29% had no PH, 63% had isolated PH, and 7% had CpcPH. Mean follow up time was 341.8 days with a total of 676.1 person-years. There was a significant difference in crude one-year mortality; 4.0 for no PH, 8.4 for isolated PH and 21.0 (per 100 person-years) for CpcPH (log rank p =0.001). Adjusted Cox proportional hazard ratios compared to patients with no PH were 1.6 (95%CI: 0.1, 3.4) for isolated PH and 5.3 (95%CI: 2.1, 13.9) for CpcPH. Conclusions: Patients with CpcPH had worse survival than patients with isolated or no PH. Diastolic pulmonary gradient should be measured as a risk marker for identifying patients at high-risk of 1-year mortality.