Prognostic Impact of Elevated Pulmonary Vascular Resistance in Group 2 Pulmonary Hypertension: Insights From a Japanese Multicenter Registry

Figures

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  Figure 1. Medical therapies for patients with HFrEF and HFpEF in the previous and current registries. “Initial treatment” refers to medications administered at the time of cardiac catheterization at the enrolling facility. “Follow‐up” indicates treatments prescribed after initial heart failure management. ACEi indicates angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; HCNi, hyperpolarization‐activated cyclic nucleotide‐gated channel inhibitor; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; Loop, loop diuretics; MRA, mineralocorticoid receptor antagonist; PH, pulmonary hypertension; sGC, soluble guanylate cyclase stimulator; and SGLT2i, sodium‐glucose cotransporter 2 inhibitor.

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  Figure 2. Prognosis of patients with Group 2 PH in previous and current registries. Kaplan–Meier curves depicting the incidence of composite end points, including cardiac death, heart failure hospitalization, left ventricular assist device implantation, and heart transplantation, during follow‐up in patients with Group 2 PH (combined cohorts, n=979, previous registry, n=425; current registry, n=563). Nine patients in the previous registries lacked PVR values, and the total number of patients classified according to PVR was 416. To account for baseline differences between patients with PVR ≤3 WU and those with PVR >3 WU, PS method was used in previous and current registries. For the calculation of PS, we used a logistic regression model in which the PVR >3 WU was regressed for the following 8 baseline characteristics: age, sex, body mass index, New York Heart Association classification, chronic kidney disease, plasma BNP and mean pulmonary artery pressure, pulmonary artery wedge pressure, and enrollment periods (current or previous). BNP indicates brain natriuretic peptide; HR, hazard ratio; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; and WU, Wood unit.

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  Figure 3. Prognosis of patients with PH‐HFrEF in previous and current registries. Kaplan–Meier curves showing the incidence of composite end points, including cardiac death, heart failure hospitalization, left ventricular assist device implantation, and heart transplantation, during follow‐up in patients with PH‐HFrEF (n=318), and PH‐HFpEF (n=245). HFpEF indicates heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; and WU, Wood unit.

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  Figure 4. Treatment with SGLT2 inhibitors ameliorated the prognosis of patients with Group 2 PH associated with PVR >3 WU. Kaplan–Meier curves for the composite end point (cardiac death, heart failure hospitalization, left ventricular assist device implantation, and heart transplantation) during follow‐up in patients with Group 2 PH, HFrEF, and HFpEF treated with or without SGLT2 inhibitors. HFpEF indicates heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HR, hazard ratio; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; SGLT2i, sodium‐glucose cotransporter‐2 inhibitor; and WU, Wood unit.