Implication of the new definition of pulmonary hypertension in patients evaluated for heart transplantation

Abstract

BackgroundThe 2018 World Symposium on Pulmonary Hypertension (WSPH) changed the definition of pulmonary hypertension (PH) with a new threshold of mean pulmonary artery pressure (mPAP) above 20 mmHg. ObjectiveTo evaluate the profile and prognosis of patients with chronic heart failure (HF) considered for heart transplantation with the new definition of PH. MethodsPatients with chronic HF considered for heart transplantation were classified as mPAP≤20mmHg, mPAP 20–25 mmHg, and mPAP≥25mmHg. Using a multivariate Cox model, we compared the mortality of patients with mPAP20–25mmHg, and mPAP≥25mmHg versus those with mPAP≤20mmHg. ResultsOf 693 patients with chronic HF considered for heart transplantation, 12.7%, 77.5% and 9.8% were classified as mPAP20–25mmHg, mPAP≥ 25mmHg and mPAP≤20mmHg. Patients of mPAP ≥ 25mmHg and mPAP 20–25 mmHg categories were older than mPAP ≤ 20 mmHg (56 versus 55 and 52 year-old, p = 0.02) with more frequent co-morbidities. Within 2.8 years, the mPAP20–25mmHg category displayed a higher risk of mortality compared with those of the mPAP≤20mmHg category (aHR 2.75, 95% CI 1.27–5.97, p = 0.01). Overall, the new PH definition using a threshold of mPAP >20 mmHg was associated with a higher risk of death (adj HR 2.71, 95% CI 1.26–5.80) than the previous definition (mPAP >25 mmHg, aHR: 1.35 95% CI 1.00–1.83, p = 0.05). ConclusionsOne out of 8 patients with severe HF are reclassified as having PH following the 2018 WSPH. Patients with mPAP20–25 evaluated for heart transplantation displayed significant co-morbidities and high mortality rates.