Clinical Significance of Reactive Post-Capillary Pulmonary Hypertension in Patients With Left Heart Disease

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Author(s)

    • TATEBE Shunsuke
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • FUKUMOTO Yoshihiro
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • SUGIMURA Koichiro
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • AOKI Tatsuo
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • MIURA Yutaka
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • NOCHIOKA Kotaro
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • SATOH Kimio
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
    • SHIMOKAWA Hiroaki
    • Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine

Abstract

<b><i>Background:</i></b> Post-capillary pulmonary hypertension (pc-PH) is a disorder with elevated pulmonary arterial pressure and pulmonary vascular resistance (PVR) because of left heart disease (LHD), and is classified as reactive (PVR >2.5 WU) or passive (PVR ≤2.5 WU). However, the clinical significance of these pc-PH subtypes remains to be elucidated. <b><i>Methods and Results:</i></b> We examined 676 consecutive patients with chronic heart failure (CHF) (NYHA ≥2), and found that 158 (23%) had pc-PH: reactive pc-PH in 58 and passive pc-PH in 100. Univariate analysis showed that 4 factors were significantly associated with reactive pc-PH and multivariate analysis showed that female sex was the only independent predictor of reactive pc-PH (odds ratio 2.12, 95% confidence interval (CI) 1.05-4.30, P=0.03). During the mean follow-up period of 2.6 years, 125 CHF patients (18%) died, including 22 with reactive pc-PH and 24 with passive pc-PH (P<0.001). Multivariate Cox regression analysis showed that elevated PVR was independently associated with higher mortality (hazard ratio 1.18, 95%CI 1.03-1.35, P=0.02). Kaplan-Meier analysis demonstrated that the prognosis of patients with reactive pc-PH was significantly worse than for those with no PH or passive pc-PH. Reactive pc-PH was a significant prognostic factor regardless of CHF etiology (ischemic vs. non-ischemic) or reduced/preserved LV ejection fraction (HFrEF vs. HFpEF). <b><i>Conclusions:</i></b> Reactive pc-PH is characterized by predominant female sex and is a significant prognostic factor of LHD with PH. (<i>Circ J</i> 2012; <b>76:</b> 1235-1244)<br>

Journal

  • Circulation Journal

    Circulation Journal 76(5), 1235-1244, 2012-04-25

    The Japanese Circulation Society

References:  37

Cited by:  1

Codes

  • NII Article ID (NAID)
    10030132858
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    13469843
  • Data Source
    CJP  CJPref  J-STAGE 
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