The prevalence and survival of pulmonary hypertension due to left heart failure: A retrospective analysis of a multicenter prospective cohort study

Yangyi Lin; Lingpin Pang; Shian Huang; Jieyan Shen; Weifeng Wu; Fangming Tang; Weiqing Su; Xiulong Zhu; Jingzhi Sun; Ruilin Quan; Tao Yang; Huijun Han; Jianguo He

doi:10.3389/fcvm.2022.908215

The prevalence and survival of pulmonary hypertension due to left heart failure: A retrospective analysis of a multicenter prospective cohort study

Front Cardiovasc Med. 2022 Aug 2:9:908215. doi: 10.3389/fcvm.2022.908215. eCollection 2022.

Authors

Yangyi Lin¹, Lingpin Pang², Shian Huang², Jieyan Shen³, Weifeng Wu⁴, Fangming Tang⁵, Weiqing Su⁶, Xiulong Zhu⁷, Jingzhi Sun⁸, Ruilin Quan¹, Tao Yang¹, Huijun Han⁹, Jianguo He¹

Affiliations

¹ Department of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Cardiovascular Medicine Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
³ Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁵ Department of Cardiology, Nongken Central Hospital of Guangdong Province, Zhanjiang, China.
⁶ Department of Cardiology, Lianjiang People's Hospital, Lianjiang, China.
⁷ Department of Cardiology, People's Hospital of Gaozhou, Gaozhou, China.
⁸ Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China.
⁹ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.

Abstract

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.

Keywords: coronary artery disease; left heart failure; mortality; prevalence; pulmonary hypertension.