HFpEF With Severe Pulmonary Hypertension Linked to Increased Mortality

Patients with heart failure, severe pulmonary hypertension, and a preserved ejection fraction of ≥50% had a worse prognosis when compared with other patients with heart failure and severe pulmonary hypertension, according to a study published in Heart and Lung.

Researchers of this prospective, observational study analyzed The Israeli Association for Cardiovascular Trials database for baseline characteristics, comorbidities, renal and heart status, and long-term prognosis of patients with heart failure and pulmonary hypertension.

Using conventional trans-thoracic echocardiograms, patients were categorized by left ventricular ejection fraction into reduced ejection fraction (<40% ejection fraction), mid-range ejection fraction (40%-49% ejection fraction), or preserved ejection fraction (≥50% ejection fraction). Using echocardiography, severe pulmonary hypertension was classified as an estimated systolic pulmonary arterial pressure of ≥50 mmHg. Demographics, echocardiography, and biochemical blood analysis were collected at baseline, follow-up evaluations were completed at 12 months, and mortality rates were assessed at 2 years.

Of the 372 patients included in this study, 56% were men, the mean age was 77.3 years old, and the mean duration of heart failure was 6.5 years. The reduced ejection fraction cohort consisted of 159 patients, the mid-range ejection fraction cohort consisted of 50 patients, and the preserved ejection fraction cohort consisted of 163 patients.

The reduced ejection fraction cohort was predominantly associated with smokers who had coronary artery disease and renal failure. The preserved ejection fraction cohort was predominantly associated with older women who were obese and had atrial fibrillation. The mid-range ejection fraction cohort did not show patterns in baseline characteristic.

Overall, 15% of the patients died by the 2-year mortality rate follow-up. Multivariable analysis indicated New York Heart Association functional class 3-4 (hazard ratio [HR] 2.41; 95% CI, 1.17-4.97; P =.017) and renal failure (HR 2.53; 95% CI 1.45-4.42; P =.001) were independent predictors for mortality. Kaplan-Meier survival curves indicated an association between severe pulmonary hypertension and mortality in the preserved ejection fraction cohort (adjusted HR 2.99; 95% CI, 1.29-6.91; P =.010) but not in the other cohorts.

Limitations of this study include only evaluating demographic, clinical, and echocardiographic information from a database, not assessing right heart parameters, and the potential for selection bias.

Researchers concluded that patients with heart failure with preserved ejection fraction and pulmonary hypertension “are likely to have different pathophysiology and worse prognosis” and “defining these patients as an independent subgroup may be more appropriate for their management and treatment.”

Reference

Zafrir B, Carasso S, Goland S, et al. The impact of left ventricle ejection fraction on heart failure patients with pulmonary hypertension [published online June 5, 2019]. Heart Lung. doi:10.1016/j.hrtlng.2019.05.006