Impact of borderline pulmonary hypertension due to left heart failure on mortality in a multicenter registry study: A 3-year survivorship analysis

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.2022.983803

Impact of borderline pulmonary hypertension due to left heart failure on mortality in a multicenter registry study: A 3-year survivorship analysis

Front Cardiovasc Med. 2022 Aug 12:9:983803. doi: 10.3389/fcvm.2022.983803. 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 & 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 Jiaotong 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 and School of Basic Medicine, Peking Union Medical College, Beijing, China.

Abstract

Background: Patients with left heart failure (LHF) are often associated with the development of pulmonary hypertension (PH) which leads to an increased risk of death. Recently, the diagnostic standard for PH has changed from mean pulmonary arterial pressure (mPAP) ≥25 mmHg to >20 mmHg. Nonetheless, the effect of borderline PH (mPAP: 21-24 mmHg) on the prognosis of LHF patients is unclear. This study aimed to investigate the relationship between borderline PH and 3-year clinical outcomes in LHF patients.

Methods: A retrospective analysis of a prospective cohort study was done for LHF patients who underwent right heart catheterization (RHC) between January 2013 and November 2016. The primary outcome was all-cause mortality; the secondary outcome was rehospitalization.

Results: Among 344 patients, 62.5% were identified with a proportion of PH (mPAP ≥ 25), 10.8% with borderline PH (21-24), and 26.7% with non-PH (≤20), respectively. Multivariable Cox analysis revealed that borderline PH patients had a higher adjusted mortality risk (HR = 3.822; 95% CI: 1.043-13.999; p = 0.043) than non-PH patients. When mPAP was treated as a continuous variable, the hazard ratio for death increased progressively with increasing mPAP starting at 20 mmHg (HR = 1.006; 95% CI: 1.001-1.012). There was no statistically significant difference in adjusted rehospitalization between borderline PH and non-PH patients (HR = 1.599; 95% CI: 0.833-3.067; p = 0.158).

Conclusions: Borderline PH is independently related to increased 3-year mortality in LHF patients. Future research is needed to evaluate whether more close monitoring, and managing with an intensifier improves clinical outcomes in borderline PH caused by LHF.

Clinical trials registration: www.clinicaltrials.gov NCT02164526.

Keywords: borderline pulmonary hypertension; left heart failure; mean pulmonary artery pressure (mPAP); mortality; right heart catheterization (RHC).

Associated data

ClinicalTrials.gov/NCT02164526