Clinical Characteristics and Long-Term Outcomes of Patients with Combined Post and Precapillary Hypertension in HFpEF

Abstract

Background The prevalence of pulmonary hypertension (PH) in HFpEF is gradually increasing. Patients with pulmonary venous hypertension due to left heart disease who develop superimposed pulmonary vascular disease are diagnosed to have HFpEF with combined post and precapillary hypertension (HFpEF-CPH). In this study we aim to investigate this subset of PH and look at clinical characteristics, biomarkers which may play a part in etiology and long-term clinical outcomes. Methods Single center prospective cohort study including 60 patients (30 control patients and 30 patients with HFpEF-CPH) who underwent right heart catherization and had Endothelin 1, Big Endothelin 1 and Neprilysin samples collected from the wedge position. They were followed for a year for hospital admission and two years for mortality. Results HFpEF-CPH patients had an average age of 53±20 years with majority being female 74% (n=22), 86% were hypertensive (n=25), 55% had Diabetes (n=16), 38% had coronary artery disease (n=11) and 51% were smoker (n=15). Patients with HFpEF-CPH were found to have elevated Endothelin 1 levels compared to control (2.5±1 pg/mL versus 1.5±1 pg/mL, p=0.00), however, no significant difference in the levels of Big Endothelin1 and Neprilysin were found between the two groups. Compared to the control group, patients with HFpEF-CPH had increased one-year hospitalization (p=0.02), increased one-year repeated hospital admissions (p=0.01) and increased mortality within the two year follow up period (p=0.03). Conclusion Increased Endothelin 1 levels observed in patients with HFpEF-CPH suggest a possible role in the etiology of this disease process and a potential target for pharmacological antagonism. Moreover, patients with HFpEF-CPH were found to have poor long-term outcomes and need to be monitored closely.