Mild pulmonary hypertension patients had a 2.07-fold higher risk of all-cause mortality or transplantation over 5 years than controls; Group 2 showed 2.88-fold increased cardiovascular mortality.
Does mild pulmonary hypertension (mPAP 21-24 mmHg, PVR >2 WU) worsen prognosis compared to non-PH controls?
Patients with mild pulmonary hypertension under updated hemodynamic criteria have a significantly worse prognosis than non-PH controls, particularly those with Group 2 and Group 3 PH.
Absolute Event Rate: 0% vs 0%
Abstract Background The haemodynamic definition of pulmonary hypertension (PH) was recently updated, lowering the threshold for mean pulmonary arterial pressure (mPAP) from ≥25 mmHg to ≥21 mmHg. However, data on the prognosis of patients with mild PH (mPAP 21–24 mmHg and pulmonary vascular resistance PVR 2 Wood units WU) remain limited, and the need for pulmonary vasodilators in this population is unclear. Purpose This study aimed to assess the prognosis, cardiovascular mortality, and progression to conventional PH in patients with mild PH, stratified by clinical classification. Methods A retrospective analysis was conducted on patients who underwent initial right heart catheterisation at a single PH centre between 2002 and 2022. Patients were classified into three groups: mild PH (n=256), conventional PH (mPAP ≥25 mmHg and PVR ≥3 WU, n=569), and controls (mPAP ≤20 mmHg and PVR ≤2 WU, n=1204). Patients were followed from the initial catheterisation, and the primary composite endpoint was all-cause mortality or transplantation (lung or heart transplantation, including left ventricular assist device implantation). Cardiovascular mortality and progression to conventional PH were also evaluated using Kaplan–Meier methods, log-rank tests, and Cox regression analyses adjusted for age and sex. Additionally, the mild PH group was stratified according to clinical classification for subgroup analysis. Results With a median follow-up of 3.8 years, the 5-year survival rates were 89% in the control group, 76% in the mild PH group, and 82% in the conventional PH group. The cumulative incidence of the composite endpoint was higher in the mild PH group than in the control group (adjusted hazard ratio HR 2.07, 95% confidence interval CI 1.51–2.82, P 0.0001). Among patients with mild PH, clinical classification identified four subgroups: Group 1 (n=36), Group 2 (n=169), Group 3 (n=32), and Group 4 (n=14). The highest cumulative incidence of the composite endpoint was observed in Group 3 (adjusted HR 4.10, 95% CI 2.31–7.25, P 0.0001), while cardiovascular mortality was elevated in Group 2 (adjusted HR 2.88, 95% CI 1.61–5.16, P = 0.0004). In contrast, Group 1 had a cardiovascular mortality rate comparable to the control group (adjusted HR 1.54, 95% CI 0.36–6.50, P = 0.5602). During follow-up, 7.8% of patients with mild PH progressed to conventional PH, with post-capillary PH being the predominant form. Conclusions Patients newly diagnosed with mild PH had a poorer prognosis than non-PH controls, with an increased proportion of patients and particularly high cardiovascular mortality in Group 2, where pulmonary vasodilators are ineffective. In contrast, Group 1 had a cardiovascular mortality rate comparable to the control group. These findings highlight the need for further investigation into risk stratification and treatment strategies for patients with mild PH.Graphical Abstract
Yamada et al. (Sat,) reported a other. Mild pulmonary hypertension patients had a 2.07-fold higher risk of all-cause mortality or transplantation over 5 years than controls; Group 2 showed 2.88-fold increased cardiovascular mortality.