Key result
Coronary artery disease shows no independent link to pulmonary hypertension due to left heart failure.
Why the study?
Despite advances in understanding pulmonary hypertension due to left heart failure, mortality remains high, prompting this study to describe prevalence, survival, and prognostic risk factors.
Cohort (n=480)
Yes
Pulmonary hypertension is present in nearly half of patients with left heart failure undergoing right heart catheterization and is associated with high long-term mortality, which can be predicted by NYHA class, hemoglobin, and systolic pulmonary artery pressure.
Answers are grounded in this paper and cite their sources.
CAD does not independently predict PH in left HF; leaves open its role in PH progression or outcomes.
Background Pulmonary hypertension due to left heart failure (PH-LHF) is currently the most common form of pulmonary hypertension (PH) encountered in clinical practice. Despite significant advances that have improved our understanding of PH-LHF over the past two decades, the mortality is still high in recent decades. This study aimed to describe the prevalence and survival of patients with PH-LHF, and explored the potential risk factors which may predict the prognosis of PH-LHF. Methods A retrospective analysis of a prospective cohort study of left heart failure (LHF) patients who underwent right heart catheterization (RHC) between January 2013 and November 2016 was performed. The endpoint was all-cause mortality. Follow-ups were performed every 6 months ± 2 weeks. Results A total of 480 patients with LHF were enrolled, with 215 (44.8%) having PH-LHF. The proportion of PH-LHF was significantly lower in coronary artery disease (CAD) group than without CAD (41.3 vs. 57.8%, p = 0.003). However, multivariable logistic regression analysis revealed that CAD was not associated with PH-LHF (Adjusted OR: 1.055, 95% CI: 0.576 – 1.935, p = 0.862). 75 of 215 (34.9%) patients with PH-LHF died during a median follow-up period of 84.6 months. The 1-, 3-, 5-, and 8-year survival rates of all PH-LHF patients were 94.3, 76.9, 65.8, and 60.2%, respectively. New York Heart Association Functional Class (NYHA FC), hemoglobin, and systolic pulmonary artery pressure (sPAP) were associated with mortality of PH-LHF in multivariate Cox analysis. Conclusion PH is commonly identified in patients with LHF, with a prevalence of approximately 45%. The mortality is still high in patients with PH-LHF. NYHA FC, hemoglobin, and sPAP are independent risk predictors of mortality for PH-LHF. These findings may be useful for risk stratification in future clinical trial enrollment.
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Lin et al. (2022) conducted a cohort in Left heart failure (LHF) (n=480). Coronary artery disease (CAD) vs. Without CAD was evaluated on Pulmonary hypertension due to left heart failure (PH-LHF) (Adjusted OR 1.055, 95% CI 0.576-1.935, p=0.862). Coronary artery disease was not independently associated with the presence of pulmonary hypertension due to left heart failure (Adjusted OR 1.055; 95% CI 0.576-1.935; P=0.862).
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