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Original research
Pulmonary hypertension with a precapillary component in heart failure with preserved ejection fraction
  1. Fusako Sera1,
  2. Tomohito Ohtani1,
  3. Shunsuke Tamaki2,
  4. Masamichi Yano3,
  5. Takaharu Hayashi4,
  6. Akito Nakagawa5,6,
  7. Yusuke Nakagawa7,
  8. Daisaku Nakatani1,
  9. Takahisa Yamada2,
  10. Yoshio Yasumura5,
  11. Shungo Hikoso1,
  12. Keiko Yamauchi-Takihara1,8,
  13. Yasushi Sakata1
  14. On behalf of Osaka Cardiovascular Conference (OCVC)-Heart Failure Investigators
  1. 1Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
  2. 2Division of Cardiology, Osaka General Medical Center, Osaka, Japan
  3. 3Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
  4. 4Department of Cardiovascular Medicine, Osaka Police Hospital, Osaka, Japan
  5. 5Division of Cardiovascular Medicine, Amagasaki Chuo Hospital, Amagasaki, Japan
  6. 6Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
  7. 7Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
  8. 8Health and Counseling Center, Osaka University, Toyonaka, Japan
  1. Correspondence to Dr Tomohito Ohtani, Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan; ohtani{at}cardiology.med.osaka-u.ac.jp

Abstract

Objectives Heart failure with preserved ejection fraction (HFpEF) is often complicated by pulmonary hypertension (PH), which is mainly characterised by postcapillary PH and occasionally accompanied by a precapillary component of PH. Haemodynamic changes in worsening heart failure (HF) can modify the characteristics of PH. However, the clinical features of PH after HF treatment in HFpEF remain unclear. We investigated the prevalence and clinical significance of the precapillary component of PH after HF treatment in HFpEF, using data from the Prospective Multicentre Observational Study of Patients with HFpEF (PURSUIT-HFpEF).

Methods From the PURSUIT-HFpEF registry, 219 patients hospitalised with acute HF who underwent right heart catheterisation after initial HF treatment were divided into four groups according to the 2015 and 2018 PH definitions: non-PH, isolated postcapillary pulmonary hypertension (Ipc-PH), precapillary PH and combined postcapillary and precapillary pulmonary hypertension (Cpc-PH). The latter two were combined as PH with the precapillary component.

Results Using the 2015 definition, we found that the prevalence of PH after HF treatment was 27% (Ipc-PH: 20%, precapillary PH: 3%, Cpc-PH: 4%). Applying the 2018 definition resulted in a doubled frequency of precapillary PH (6%). PH with a precapillary component according to the 2015 definition was associated with poor clinical outcomes and characterised by small left ventricular dimension and high early diastolic mitral inflow velocity/early diastolic mitral annular tissue velocity.

Conclusion After initial HF treatment, 7% of hospitalised patients with HFpEF had precapillary component of PH according to the 2015 definition. Echocardiographic parameters of the left ventricle can contribute to the risk stratification of patients with HFpEF with a precapillary component of PH.

  • heart failure
  • haemodynamics
  • echocardiography
  • hypertension, pulmonary

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Collaborators On behalf of Osaka Cardiovascular Conference Heart Failure Investigators.

  • Contributors FS: conception, design of analysis, interpretation of data and manuscript drafting. TO: guarantor, conception, design of analysis, interpretation of data and revision of the manuscript for important intellectual content. ST, MY, TH, AN, YN and KY-T: interpretation of data and revision of the manuscript for important intellectual content. DN: project administration and revision of the manuscript for important intellectual content. TY and YY: supervision and revision of the manuscript for important intellectual content. SH: funding acquisition, project administration, interpretation of data and critical revision of the manuscript for important intellectual content. YS: funding acquisition, supervision and revision of the manuscript for important intellectual content. All authors read and gave the final approval of the manuscript.

  • Funding SH and YS were supported by Roche Diagnostics K.K. and Fuji Film Toyama Chemical Co., and FS was supported by JSPS KAKENHI (JP18K08070).

  • Competing interests FS received modest lecture fees from Actelion Pharmaceuticals, Pfizer and Nippon Boehringer Ingelheim. TO received modest lecture fees from Bristol-Myers Squibb, Daiichi Sankyo Company, Nippon Boehringer Ingelheim and Otsuka Pharmaceutical, as well as significant medical advisory fees from Takeda Pharmaceutical. SH received modest personal fees from Daiichi Sankyo Company, Bayer and Astellas Pharma, as well as a modest grant from Actelion Pharmaceuticals. KY-T received a modest lecture fee from Actelion Pharmaceuticals. YS received significant personal fees from Otsuka Pharmaceutical and Daiichi Sankyo Company, and modest personal fees from Actelion Pharmaceuticals, Ono Pharmaceutical, Astellas Pharma, AstraZeneca, Novartis Pharma, Bayer, Pfizer and TOA EIYO. The other authors have no conflicts of interest to disclose.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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