Pulmonary hypertension in ischemic heart failure: a pilot study

Aim. To evaluate the role of cardiopulmonary system assessment in a group of patients with pulmonary hypertension (PH) associated with ischemic heart failure (HF) with the right ventricular-pulmonary arterial (RV-PA) coupling. Material and methods. Forty stable patients were examined. The patients were divided into 3 groups depending on the left ventricle ejection fraction (LVEF). PH was established by using expert transthoracic echocardiography. RV-PA coupling was calculated by 2 following ways: as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio and as TAPSE´Pulmonary Artery Aceleration Time (pACT) multiplication. Results. The patients included in the study were mainly men (73,8%), functional class PH II-III (95,2%), stage IIB CHF (62%). The highest values of TAPSE (18,6±3 mm) and RV-PA coupling (0,64±0,42 mm/mm Hg) were found in the patients with preserved LVEF. In the general cohort, high level of NT-proBNP corresponds to reduced values of RVPA coupling (r s =-0,563) and TAPSE (r s =-0,666; p<0,01). The severity of PH directly affects the level of NT-proBNP (p<0,01). As the stage of HF and PH functional class increases, the indicators of PASP, inferior vena cava diameter and NT-proBNP level significantly increase, as well as TAPSE and RV-PA coupling decrease (p<0,05). Different calculating methods of RV-PA coupling has a strong correlation (r s =0,832; p<0,01). Conclusion. The right heart and RV-PA coupling assessment in patients with ischemic HF of origin is of significant value for the early diagnosis of PH and timely clinical decision-making.