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Pulmonary Hypertension Phenotype Can Be Identified in Heart Failure With Reduced Ejection Fraction Using Echocardiographic Assessment of Pulmonary Artery Pressure With Supportive Use of Pressure Reflection Variables

Bech-Hanssen, Odd ; Smith, J. Gustav LU ; Astengo, Marco ; Bollano, Entela ; Bobbio, Emanuele ; Polte, Christian Lars ; Bergh, Niklas and Karason, Kristjan (2023) In Journal of the American Society of Echocardiography 36(6). p.604-614
Abstract

Background: Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with 2 different phenotypes: isolated postcapillary PH (IpcPH) and, with the worst prognosis, combined pre- and postcapillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure >20 mm Hg) and (2) the relationship between PH phenotype and right ventricular (RV) function. Methods: One hundred twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure workup were included with echocardiography and right heart... (More)

Background: Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with 2 different phenotypes: isolated postcapillary PH (IpcPH) and, with the worst prognosis, combined pre- and postcapillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure >20 mm Hg) and (2) the relationship between PH phenotype and right ventricular (RV) function. Methods: One hundred twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure workup were included with echocardiography and right heart catheterization within 48 hours. We estimated systolic pulmonary artery pressure (sPAPDoppler) and used a method to detect increased pulmonary vascular resistance (>3 Wood units) based on predefined thresholds of 3 pressure reflection (PRefl) variables (the acceleration time in the RV outflow tract [RVOT], the interval between peak RVOT and peak tricuspid regurgitant velocity, and the RV pressure augmentation following peak RVOT velocity). Results: Using receiver operator characteristic analysis in a derivation group (n = 62), we identified sPAPDoppler ≥35 mm Hg as a cutoff that in a test group (n = 62) increased the likelihood of PH 6.6-fold. The presence of sPAPDoppler >40 mm Hg and 2 or 3 positive PRefl variables increased the probability of CpcPH 6- to 8-fold. A 2-step approach with primarily assessment of sPAPDoppler and the supportive use of PRefl variables in patients with mild/moderate PH (sPAPDoppler 41-59 mm Hg) showed 76% observer agreement and a weighted kappa of 0.63. The steady-state (pulmonary vascular resistance) and pulsatile (compliance, elastance) vascular loading are increased in both IpcPH and CpcPH with a comparable degree of RV dysfunction. Conclusions: The PH phenotype can be identified in HFrEF using standard echocardiographic assessment of pulmonary artery pressure with supportive use of PRefl variables in patients with mild to moderate PH.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Echocardiography, Heart failure with reduced ejection fraction, Left heart disease, Pulmonary hypertension phenotype
in
Journal of the American Society of Echocardiography
volume
36
issue
6
pages
604 - 614
publisher
Elsevier
external identifiers
  • pmid:36681129
  • scopus:85148751433
ISSN
0894-7317
DOI
10.1016/j.echo.2023.01.011
language
English
LU publication?
yes
id
af5f8f43-cd66-435d-820e-9e7e36915f07
date added to LUP
2023-03-16 15:49:15
date last changed
2024-11-01 01:00:12
@article{af5f8f43-cd66-435d-820e-9e7e36915f07,
  abstract     = {{<p>Background: Pulmonary hypertension (PH) is frequent in patients with heart failure and reduced ejection fraction (HFrEF) with 2 different phenotypes: isolated postcapillary PH (IpcPH) and, with the worst prognosis, combined pre- and postcapillary PH (CpcPH). The aims of the present echocardiography study were to investigate (1) the ability to identify PH phenotype in patients with HFrEF using the newly adopted definition of PH (mean pulmonary artery pressure &gt;20 mm Hg) and (2) the relationship between PH phenotype and right ventricular (RV) function. Methods: One hundred twenty-four patients with HFrEF consecutively referred for heart transplant or heart failure workup were included with echocardiography and right heart catheterization within 48 hours. We estimated systolic pulmonary artery pressure (sPAP<sub>Doppler</sub>) and used a method to detect increased pulmonary vascular resistance (&gt;3 Wood units) based on predefined thresholds of 3 pressure reflection (PRefl) variables (the acceleration time in the RV outflow tract [RVOT], the interval between peak RVOT and peak tricuspid regurgitant velocity, and the RV pressure augmentation following peak RVOT velocity). Results: Using receiver operator characteristic analysis in a derivation group (n = 62), we identified sPAP<sub>Doppler</sub> ≥35 mm Hg as a cutoff that in a test group (n = 62) increased the likelihood of PH 6.6-fold. The presence of sPAP<sub>Doppler</sub> &gt;40 mm Hg and 2 or 3 positive PRefl variables increased the probability of CpcPH 6- to 8-fold. A 2-step approach with primarily assessment of sPAP<sub>Doppler</sub> and the supportive use of PRefl variables in patients with mild/moderate PH (sPAP<sub>Doppler</sub> 41-59 mm Hg) showed 76% observer agreement and a weighted kappa of 0.63. The steady-state (pulmonary vascular resistance) and pulsatile (compliance, elastance) vascular loading are increased in both IpcPH and CpcPH with a comparable degree of RV dysfunction. Conclusions: The PH phenotype can be identified in HFrEF using standard echocardiographic assessment of pulmonary artery pressure with supportive use of PRefl variables in patients with mild to moderate PH.</p>}},
  author       = {{Bech-Hanssen, Odd and Smith, J. Gustav and Astengo, Marco and Bollano, Entela and Bobbio, Emanuele and Polte, Christian Lars and Bergh, Niklas and Karason, Kristjan}},
  issn         = {{0894-7317}},
  keywords     = {{Echocardiography; Heart failure with reduced ejection fraction; Left heart disease; Pulmonary hypertension phenotype}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{604--614}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the American Society of Echocardiography}},
  title        = {{Pulmonary Hypertension Phenotype Can Be Identified in Heart Failure With Reduced Ejection Fraction Using Echocardiographic Assessment of Pulmonary Artery Pressure With Supportive Use of Pressure Reflection Variables}},
  url          = {{http://dx.doi.org/10.1016/j.echo.2023.01.011}},
  doi          = {{10.1016/j.echo.2023.01.011}},
  volume       = {{36}},
  year         = {{2023}},
}