Increased Risk for Adverse Outcomes With Mild Pulmonary Hypertension in HFpEF - The Cardiology Advisor

Increased Risk for Adverse Outcomes With Mild Pulmonary Hypertension in HFpEF - The Cardiology Advisor

Increased Risk for Adverse Outcomes With Mild Pulmonary Hypertension in HFpEF - The Cardiology Advisor

Posted: 20 May 2019 12:00 AM PDT

Patients with heart failure with preserved ejection fraction (HFpEF) who have mild pulmonary hypertension (PH) are at increased risk for adverse clinical outcomes, according to a review published in the American Journal of Respiratory and Critical Care Medicine.1

PH is a prevalent HFpEF subphenotype that is due to pulmonary venous and pre-capillary remodeling from left atrial hypertension.3-5 Previous studies conducted in the United States have demonstrated a wide continuum of clinical risk relative to mean pulmonary artery pressure (mPAP), including hospitalization and mortality, which changed the mPAP threshold for defining PH in the setting of left heart disease from >25 mmHg to >20 mmHg.2,6-8,9-11

Researchers sought to determine whether mPAP 20 to 24 mmHg is an independent predictor of clinical events in HFpEF and whether the association of mPAP >20 mmHg is generalizable to international HFpEF populations.1

A study of patients hospitalized for heart failure (HF) in Japan demonstrated an increased risk for future HF hospitalizations with an mPAP ≥20 mmHg, and even in patients with an mPAP ≥15 mmHg.12

A significant increase in the risk for adverse clinical outcome was maintained in several multivariate analyses.1 This study included a relatively small sample size of 183 patients, and therefore larger international studies are needed.

The review authors concluded that, "Viewing mild PH in a new light — as a high-risk clinical parameter in HFpEF — could pave a way forward for early intervention (eg, diet modification, prescription exercise enhanced diabetes control) irrespective of symptom burden."1 They added that, "In principle, such a shift may ultimately give rise to opportunities for HFpEF (or PH) prevention."

Related Articles

References

  1. Simon MA, Maron BA. Pulmonary hypertension in heart failure with preserved ejection fraction patients: where to draw the line [published online April 30, 2019]. Am J Respir Crit Care Med. doi: 10.1164/rccm.201903-0689ED
  2. Vanderpool RR, Saul M, Nouraie M, Gladwin MT, Simon MA. Association between hemodynamic markers of pulmonary hypertension and outcomes in heart failure with preserved ejection fraction. JAMA Cardiol. 2018;3:298-306.
  3. Maron BA, Galie N. Diagnosis, treatment, and clinical management of pulmonary arterial hypertension in the contemporary era: a review. JAMA Cardiol. 2016;1:1056-1065.
  4. Guazzi M, Gomberg-Maitland M, Arena R. Pulmonary hypertension in heart failure with preserved ejection fraction. J Heart Lung Transplant. 2015;34:273-281.
  5. Rosenkranz S, Gibbs JS, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiery JL. Left ventricular heart failure and pulmonary hypertension. Eur Heart J. 2016;37:942-954.
  6. Maron BA, Hess E, Maddox TM, et al. Association of borderline pulmonary hypertension with mortality and hospitalization in a large patient cohort: insights from the Veterans Affairs clinical assessment, reporting, and tracking program. Circulation. 2016;133:1240-1248.
  7. Assad TR, Maron BA, Robbins IM, et al. Prognostic effect and longitudinal hemodynamic assessment of borderline pulmonary hypertension. JAMA Cardiol. 2017;2:1361-1368.
  8. Maron BA, Brittain EL, Choudhary G, Gladwin MT. Redefining pulmonary hypertension. Lancet Respir Med. 2018;6:168-170.
  9. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53:1801913.
  10. Kovacs G, Avian A, Tscherner M, et al. Characterization of patients with borderline pulmonary arterial pressure. Chest. 2014;146:1486-1493.
  11. Maron BA, Wertheim BM, Gladwin MT. Under pressure to clarify pulmonary hypertension clinical risk. Am J Respir Crit Care Med. 2018;197:423-426.
  12. Nishihara T, Yamamoto E, Tokitsu T, et al. New definition of pulmonary hypertension in heart failure with preserved ejection fraction patients [printed online March 27, 2019]. Am J Respir Crit Care Med. doi: 10.1164/rccm.201901-0148LE     

Topics:

Heart Failure Pulmonary Hypertension

Comments

Post a Comment

Popular posts from this blog

Novitium's Generic Sildenafil for PAH Treatment Approved by FDA - Pulmonary Hypertension News

Image
Novitium's Generic Sildenafil for PAH Treatment Approved by FDA - Pulmonary Hypertension News Novitium's Generic Sildenafil for PAH Treatment Approved by FDA - Pulmonary Hypertension News Growing Doubt, Uncertainty Over PDE5i Use in Left Heart Disease - Medscape AnMed Health gains national recognition through the Pulmonary Hypertension Association - WSPA.com Novitium's Generic Sildenafil for PAH Treatment Approved by FDA - Pulmonary Hypertension News Posted: 12 Jun 2019 05:00 AM PDT The U.S. Food and Drug Administration (FDA) has approved Novitium Pharma 's generic sildenafil for oral suspension at a dose of 10 mg/mL for the treatment of pulmonary arterial hypertension (PAH). This product, which had been designated a competitive generic therapy by the FDA, is the first approved generic equivalent to Pfizer 's Revatio , a vasodilator agent that induces blood ves...
Read more

Epoprostenol Via High-Flow Nasal Cannula Improves Severe Hypoxemia in PH - Pulmonology Advisor

Image
Epoprostenol Via High-Flow Nasal Cannula Improves Severe Hypoxemia in PH - Pulmonology Advisor Epoprostenol Via High-Flow Nasal Cannula Improves Severe Hypoxemia in PH - Pulmonology Advisor Posted: 11 Jul 2019 12:00 AM PDT For patients with severe hypoxemia with pulmonary hypertension or right heart dysfunction, inhaled epoprostenol through high-flow nasal cannula increases oxygenation, according to a study published in Pharmaceutics . The researchers of this retrospective study assessed the effect of inhaled epoprostenol using a high-flow nasal cannula on oxygenation and future mechanical ventilation in patients with hypoxemia comorbid with pulmonary hypertension or right heart dysfunction in an intensive care unit setting. A chart review was completed on adult patients who were admitted into the respiratory care department of the Rush University Medical Center for severe hypoxemia between July 2015 and April 2018 and treated with inha...
Read more

Analysis: Large pharma companies do little new drug innovation - STAT

Image
Analysis: Large pharma companies do little new drug innovation - STAT Analysis: Large pharma companies do little new drug innovation - STAT Gene Therapy Takes Center Stage at 2019 NORD Summit - Pulmonary Hypertension News People Living With Type 2 Diabetes Want Information and Empathy From Their Doctors More Than New Medications - PRNewswire Analysis: Large pharma companies do little new drug innovation - STAT Posted: 10 Dec 2019 01:51 AM PST L arge pharmaceutical companies oppose legislation being considered by Congress to lower the prices of prescription drugs. Reducing their revenues, they contend, will reduce their investment in drug development and the discovery of new medicines, and thus lead to a decline in drug innovation. If that argument is credible, there should be evidence to show that the large pharmaceutical companies are responsible for discovering innovative new drugs. To test that claim, we examined the...
Read more