Prevalence and determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF). FRESH study from GICC

Abstract

To investigate the prevalence and the determinants of pulmonary arterial hypertension (PAH) in acute and chronic heart failure (CHF) in France. The epidemiology of PAH in France in CHF is poorly described. FRESH is an ongoing multicenter survey collecting exhaustive data in both acute and chronic HF ( NCT01956539 ). Estimate of systolic pulmonary artery pressure (SPAP) was attempted routinely by echocardiography and was divided in three classes: ≥ 45 mmHg (Gr3), < 45 mmHg (Gr2) and not measured/able (Gr1). The diagnosis of CHF was based on symptoms, signs, echocardiography NTproBNP. Comparisons were performed using χ 2 tests for categorical variables and ANOVA or non-parametric Kruskal–Wallis test for continuous variables. Logistic regression was used to identify factors associated with PAPS ≥ 45 mmHg (Gr3). Overall, 2093 patients were included in FRESH. One thousand and six hundred and ninety (81%) had an echocardiography of whom 596 (35%) were in AHF, of whom 29%, 34%% and 37% were respectively in Gr1, Gr2 and Gr3 and 1094 (65%) were in CHF of whom 31%, 48%, 21% were respectively in Gr1, Gr2 and Gr3. Independent factors associated with Gr3 (vs Gr1 and Gr2 pooled) were mitral insufficiency, high grade NYHA (III/IV), increased BNP, increased LVEDD and reduced TAPSE ( Table 1 ). Using a definition of PASP > 45 mmHg, 37% of patients with AHF and 21% of CHF had pulmonary hypertension, which was associated with LV remodeling and mitral insufficiency leading to right ventricle failure. Whether PAH a target for therapy in these populations remains to be elucidated.