A National Prospective Multicenter Registry Of Pulmonary Hypertension Due To Left Heart Failure

Objectives:The first purpose of this study was to investigate the prevalence,baseline characteristics,and prognostic features of pulmonary hypertension in patients with left heart failure in China,and to identify the risk factors associated with pulmonary hypertension due to left heart disease(PH-LHD)and the risk factors affecting PH-LHD's survival.Another purpose was to compare the baseline characteristics and prognostic features of isolated post-capillary pulmonary hypertension(Ipc-PH)and combined post-capillary and pre-capillary pulmonary hypertension(Cpc-PH),and to explore the risk factors associated with the occurrence of CPC-PH.Methods:From October,2012 to November,2016,patients diagnosed as heart failure with preserved ejection fraction(HFpEF)and heart failure with reduced ejection fraction(HFrEF)were prospectively enrolled in 11 centers across the country.Right heart catheter examinations were performed to evaluate the hemodynamic parameters of the pulmonary circulation.At the same time,baseline information such as vital signs,symptoms,echocardiography parameters,serological tests,and comorbidities were collected.Patients were followed up every 6 months and the primary endpoint was all-cause mortality.Pulmonary artery mean pressure?25mmHg,Pulmonary capillary wedge pressure(PCWP)>15mmHg was uesd as the diagnostic criteria for PH-LHD,and diastolic pulmonary gradient(DPG)? 7mmHg was used as the cut-off value to divide PH-LHD patients into Ipc-PH and Cpc-PH.The baseline characteristics and survival of patients with and without PH,Ipc-PH and Cpc-PH in HFpEF and HFrEF cohorts were seperately compared.Logistic regression analysis was used to analyze the risk factors associated with PH and Cpc-PH.COX regression analysis was used to analyze the risk factors predicting PH-LHD' s survival.Results:A total of 378 HFpEF patients and 111 HFrEF patients were enrolled.The prevalence of PH in HFpEF was 57.7%,and the prevalence of PH in HFrEF was 71.2%.The pulmonary capillary wedge pressure and mean right atrial pressure were both higher in patients with PH-LHD than those without P H.PCWP(HR 3.623,95%CI:2.197-5.976,p<0.001),NYHA functional class(HR1.86,95%Cl:1.053-3.285,p=0.033),left atrial diameter(HR 1.888,95%Cl:1.041-3.425,p=0.036)were independent predictors of PH in HFpEF,while PCWP(HR 4.936,95%CI:1.715-14.204,p=0.003),BMI(HR 3.924,95%CI:1.069-14.413,p=0.039)were independent predictors of PH in HFrEF.After a follow-up of 34.57(23.3,40.4)months.the mortality of patients with PH in HFrEF was higher,and the 2-year survival rate of PH patients was significantly lower than that of patients without PH in HFpEF.Pulmonary artery mean pressure(HR 1.419,95%CI:1.071-1.880,p=0.015),male(HR 2.367,95%CI:1.026-5.46,p=0.043),hemoglobin concentration(HR 1.385,95%CI:1.134-1.67,p=0.001)independently predicted mortality of PH-LHD in HFpEF.For HFrEF patients,age(HR 2.189,95%CI:1.176-4.074,p=0.013)and systemic diastolic pressure(HR 3.583,95%CI:1.069-12.006,p=0.039)were independent predictors for PH-LHD's mortality.The pulmonary arterial pressures and right atrial mean pressure in patients with Cpc-PH were higher than those in patients with Ipc-PH.Elevated serum uric acid(HR 1.322,95%CI:1.008-1.727,p=0.043)was an independent risk factor for Cpc-PH in the HFpEF cohort,while diabetes(HR 4.224,95%CI:1.382-12.908,p=0.011),age(HR 4.306,95%CI:1.433-12.943,p=0.009)and NYHA functional class(HR 3.365,95%CI:1.084-10.452,p=0.036)were independent risk factors for Cpc-PH in the HFrEF cohort.3 years' mortality of Cpc-PH patients in the HFpEF cohort was significantly higher than that of Ipc-PH patients(27.2%vs.12.6%,Log-rank test:p=0.007);In the subgroup with a systolic diastolic blood pressure>70 mmHg in HFrEF cohort,3 years' mortality of Cpc-PH was also found to be significantly higher than Ipc-PH Patients.Conclusions:The prevalence of PH in patients of left heart failure is high in China,and PH-LHD patients tend to have greater disease severity.Pulmonary capillary wedge pressure and left atrial size,NYHA functional class,and BMI are related to the occurrence of PH-LHD.The mortality rate of patients with PH is higher,and the prognosis of PH-LHD should be judged comprehensively based on the type of heart failure,PH-LHD hemodynamic phenotype and clinical indicators.