Abstract Rationale Pulmonary hypertension (PH) is associated with significant morbidity and mortality, likely due to its indolent course with subtle clinical manifestations. Pre-capillary PH in the setting of chronic lung disease (CLD) occurs due to hypoxic vasoconstriction. Post-capillary PH progresses when as left heart failure leads to increased pressure from blood pooling in the pulmonary circulation. We hypothesized that survival would differ between pure pre-capillary PH versus combined pre- and post-capillary PH in patients with CLD. Methods This was a retrospective cohort study of patients with CLD who were evaluated for pure pre-capillary PH or combined PH diagnosed via right heart catheterization. Pre-capillary PH was defined as mPAP 20 mmHg, PVR 2 WU, and PCWP ≤15 mmHg. Combined pre- and post-capillary PH was defined as mPAP 20 mmHg, PVR 2 WU, and PCWP 15 mmHg. Underlying CLDs included COPD, IPF, other pulmonary fibrosis, non-fibrotic ILD, and pulmonary sarcoidosis. Clinical characteristics were compared between those with pre-capillary PH and those with combined PH via t-test and chi-square analysis as indicated. Outcomes of lung transplant and death before transplant were compared between the two groups, and Kaplan Meier survival analysis was performed. Results The distributions of underlying CLD among patients with pure pre-capillary PH (n = 558) and combined PH (n = 187) were significantly different (p 0.05). Patients with CLD and pure pre-capillary PH had significantly higher oxygen requirements, cardiac index, and PVR (p 0.05) than those with combined PH. Combined PH patients had significantly higher mean RA pressure, PCWP, and systolic and mean PA pressures (p 0.05). Those with pure pre-capillary PH had a significantly higher rate of lung transplantation than the combined PH group (57.7% vs 44.9%, p 0.05). Patients with combined PH had a higher proportion of patients dying before potential transplant (22.3% vs 16.8%), although not statistically significant (p = 0.13). Overall, survival probability via Kaplan Meier analysis was similar among the two groups (log rank p = 0.77, Figure 1). Conclusion Survival probability was similar between CLD patients with pre-capillary PH and combined pre- and post-capillary PH. Despite this, a significantly higher proportion of pre-capillary PH-CLD patients received lung transplant, while a higher proportion of the combined PH patients died before a potential lung transplant. This lower proportion of lung transplantation and higher proportion of death among those with CLD and combined PH warrants further investigation, particularly as it relates to pulmonary vasodilator therapy and GDMT for left ventricular cardiac disease. This abstract is funded by: None
Peluzzo et al. (Fri,) studied this question.