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Prevalence and Risk Factors of Pulmonary Hypertension in Patients With Elevated Pulmonary Venous Pressure and Preserved Ejection Fraction

https://doi.org/10.1016/j.amjcard.2010.02.039Get rights and content

Pulmonary hypertension (PH) is a well-recognized complication of left-sided heart failure with preserved left ventricular systolic function that portends a worse prognosis. The identification of risk factors may provide insight into possible mechanisms for the development of PH in this population. Targeting these risk factors could possibly attenuate the development of PH. The limited data available regarding the prevalence of PH and its risk factors in patients with heart failure with preserved left ventricular systolic function are based on echocardiography. To further study this, an institutional database was searched for all patients who underwent right-sided and left-sided cardiac catheterization with ventriculography from October 1996 to September 2007 who met the following criteria: left ventricular end-diastolic pressure (LVEDP) >15 mm Hg, a left ventricular ejection fraction ≥50%, and no significant left-sided cardiac valvular disease. The demographic, clinical, and hemodynamic data of these patients were then analyzed. Of 455 patients who met these criteria, 239 (52.5%) had PH, defined as mean pulmonary artery pressure >25 mm Hg. Using multivariate logistic regression, PH was strongly and independently associated with LVEDP ≥25 mm Hg (odds ratio 4.3), morbid obesity (odds ratio 3.4), and atrial arrhythmias (odds ratio 3.1). Other significant associations were age ≥80 years, chronic obstructive pulmonary disease, and dyspnea on exertion. In conclusion, PH is a frequent finding in patients with elevated LVEDPs and preserved left ventricular systolic function. Factors associated with its development are LVEDP ≥25 mm Hg, morbid obesity, atrial arrhythmias, age ≥80 years, chronic obstructive pulmonary disease, and dyspnea on exertion.

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Methods

The Dartmouth Dynamic Registry collects clinical, demographic, and procedural data on all patients who undergo cardiac catheterization at Dartmouth-Hitchcock Medical Center. The database was searched for patients who underwent right-sided and left-sided cardiac catheterization with LVEDPs >15 mm Hg, LV ejection fractions ≥50%, and no clinically significant aortic or mitral valve disease (no more than mild) from October 1996 to September 2007. The indication for heart catheterization was

Results

Among 3,097 patients who underwent right-sided and left-sided cardiac catheterization with ventriculography from October 1996 to September 2007, 455 were found to have LVEDPs >15 mm Hg, preserved LV systolic function, and no significant left-sided valvular disease. Of these, 239 (52.5%) had mean PA pressures >25 mm Hg. The demographic, clinical, and hemodynamic characteristics of our sample are listed in Table 1.

Patients with PH were more likely to be older and obese; to have diabetes, chronic

Discussion

Our study shows that the development of PH in patients with elevated LVEDPs and preserved systolic function is strongly and independently associated with LVEDP ≥25 mm Hg, body mass index >40 kg/m2, and atrial arrhythmias. Other significant independent associations were age ≥80 years, chronic obstructive pulmonary disease, and dyspnea on exertion. The prevalence of PH in our study population was 52.5%. Lam et al2 reported a PH prevalence of 83% in their echocardiography-based study of patients

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