SESSION TYPE: Pulmonary Hypertension II
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: Patients with left sided heart failure with preserved ejection fraction (HFpEF) have elevated pulmonary artery pressures because of increased filling pressure. Presence of pulmonary hypertension is associated with worse survival. This study evaluates the safety and relevance of acute vasodilator response (AVR) in patients with HFpEF.
METHODS: This is a prospective cohort study of consecutive patients undergoing diagnostic right heart catheterization for suspected pulmonary hypertension from 1/2004 to 3/2012. Subjects were included if mPA > 25 and PW > 15 mm Hg. Pulmonary hemodynamics were measured at baseline, and following the administration of inhaled nitric oxide at 10 - 20 parts per million for 10 minutes. In patients with PW > 15, vasodilator testing was performed at the discretion of the operator. AVR was assessed by two criteria: Rich (1992): decrease in mPA and PVR of ≥ 20% and Sitbon (2005): decrease in mPA of ≥ 10 mmHg reaching mPA value of ≤ 40 mmHg and increased or unchanged cardiac output.
RESULTS: Of 51 patients with HFpEF, 39 patients underwent right heart catheterization with vasodilator testing. The patients who did and did not undergo vasodilator testing were similar in terms of age, gender and baseline hemodynamics. The mean age was 66 ± 12 years, and 80% were females. All patients tolerated inhaled nitric oxide well. The mPA was 40 ± 11 mmHg and mean PVR was 391 ± 358 dynes.sec.cm-5. Median follow-up was 2.4 years (IQR 1.2 - 4.8 years). There were 10 deaths (26%) during study period. There were 7 cases (Rich, 18%) and 2 cases (Sitbon, 5%) who had an AVR. Presence of AVR by either criterion demonstrated no difference in survival (Rich p 0.30, Sitbon p 0.43) Cardiac index was independently associated with survival (HR 0.15, p 0.03).
CONCLUSIONS: Cardiac index but not AVR was independently associated with survival in patients with HFpEF.
CLINICAL IMPLICATIONS: AVR is safe in patients with HFpEF; however, unlike in PAH, it does not appear to be associated with a survival benefit.
DISCLOSURE: The following authors have nothing to disclose: Nadine Al-Naamani, Stefan Richter, Ioana Preston, Nicholas Hill, Kari Roberts
No Product/Research Disclosure InformationTufts Medical Center, Boston, MA