Occurrence and characteristics of pulmonary hypertension in heart failure with reduced ejection fraction undergoing right heart catheterization - high-volume centre experience

Background/Introduction Pulmonary hypertension (PH) due to left heart disease worsens the clinical status and the prognosis of heart failure (HF) patients [1]. It is important to diagnose it, as combined post- and pre-capillary PH (CpcPH) with severe pre-capillary component requires an individualized approach to the treatment (I C class recommendation) [1]. Purpose The study aimed to assess the prevalence of PH due to left heart disease and its types: isolated postcapillary PH (IpcPH) and CpcPH in patients undergoing right heart catheterization (RHC). Methods The study sample consists of 564 patients with HF with reduced ejection fraction (HFrEF) undergoing elective RHC. PH was diagnosed according to the ESC 2022 guidelines: mean pulmonary artery pressure (mPAP) >=20 mmHg [1]. IpcPH was diagnosed when pulmonary arterial wedge pressure (PAWP) was > 15 mmHg and pulmonary vascular resistance (PVR) <=2 Wood units; CpcPH was diagnosed when PAWP was > 15 mmHg and a PVR > 2 Wood units [1]. In the case of PH and PAWP below 15 mmHg and PVR ≤2 Wood units, unclassified PH was diagnosed [1]. Results The study group included 15.4% women, a mean age was 51.9 ± 11.3 years, and a mean left ventricular ejection fraction (LVEF) was 21.0 ± 7.0%. Considering the NYHA class, 29.6% were in the I or II class, 55.9% in the III class, and 14.5% in the IV class. More than two-thirds of the patients had PH - 68.4%. Patients with CpcPH constituted 45.9% of the enrolled cohort, and 21.4% had IpcPH. Unclassified PH was diagnosed in 1.1% of patients. CpcPH with severe pre-capillary component (PVR>5 Wood units) was recognized in 9.9% of the group. Conclusion PH is a prevalent comorbidity in HFrEF. The majority of patients with PH had combined post- and pre-capillary PH. CpcPH with severe pre-capillary component was relatively common with an incidence of 1 for 10 HFrEF patients – according to ESC guidelines, an individualized approach to treatment is recommended in this group (I C class recommendation). It underlines the importance of RHC as the gold standard for PH diagnosing in managing HFrEF patients.