Abstract
BackgroundThe hemodynamic definitions of pulmonary hypertension (PH) in left heart disease have recently been refined to better match the characteristics required to reflect the presence of pulmonary vascular disease. Accordingly, we tested the hypothesis that abnormalities in the stiffness of pulmonary circulation would persist after heart transplantation in patients with combined post-capillary and pre-capillary PH (Cpc-PH) in contrast to those with isolated post-capillary PH (Ipc-PH).MethodsWe retrospectively analyzed right heart hemodynamics in a cohort of 295 consecutive patients with heart failure and advanced left ventricular systolic dysfunction (LVSD) before and 1 year after heart transplantation.ResultsAccording to their baseline hemodynamic profile, patients were classified as: 75 Cpc-PH, 111 Ipc-PH, and 98 without PH (no-PH), and 11 pre-capillary PH. One year after heart transplantation, pulmonary artery pressures, pulmonary vascular resistance and cardiac index normalized in all patients regardless of the baseline hemodynamic profile. However, pulmonary arterial compliance remained lower in Cpc-PH patients (from 1.6±1.2 at baseline to 3.7±1.4 ml/mmHg at 1 year) than in Ipc-PH (from 1.2±2.0 to 4.4±2.3 ml/mmHg) and no-PH patients (from 3.7±2.0 to 4.5±1.8 ml/mmHg); (adjusted p = 0.03 Ipc-PH vs. Cpc-PH INT<0.001).ConclusionsIn heart failure patients with advanced LVSD, a hemodynamic profile characterized by Cpc-PH predicts the persistence of a stiffer pulmonary circulation at 1 year after heart transplantation.
Highlights
The hemodynamic definitions of pulmonary hypertension (PH) in left heart disease have recently been modified in the European Guidelines to better match the characteristics required to reflect the presence of pulmonary vascular disease
Pulmonary arterial compliance remained lower in capillary and pre-capillary PH (Cpc-PH) patients than in isolated post-capillary PH (Ipc-PH) and no-PH patients;
In heart failure patients with advanced left ventricular systolic dysfunction (LVSD), a hemodynamic profile characterized by Cpc-PH predicts the persistence of a stiffer pulmonary circulation at 1 year after heart transplantation
Summary
The hemodynamic definitions of pulmonary hypertension (PH) in left heart disease have recently been modified in the European Guidelines to better match the characteristics required to reflect the presence of pulmonary vascular disease. Definitions include the diastolic pressure gradient (DPG), reported to be a more stable hemodynamic parameter than pulmonary vascular resistances (PVR) or transpulmonary gradient (TPG) [1]. Pulmonary arterial compliance (PCa) is increasingly recognized as a parameter of clinical and prognostic relevance in patients with different classes and forms of PH. It has been suggested that a reduced PCa may be the most important hemodynamic feature in early stages of pre-capillary forms of pulmonary hypertension [10]. The hemodynamic definitions of pulmonary hypertension (PH) in left heart disease have recently been refined to better match the characteristics required to reflect the presence of pulmonary vascular disease. We tested the hypothesis that abnormalities in the stiffness of pulmonary circulation would persist after heart transplantation in patients with combined post-capillary and pre-capillary PH (Cpc-PH) in contrast to those with isolated post-capillary PH (Ipc-PH)
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