Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: Role of the pre-capillary component
In pulmonary hypertension (PH), both wedge pressure elevation (PAWP) and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis. We aimed at describing the different haemodynamic phenotypes of patients with PH due to left heart...
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| description | In pulmonary hypertension (PH), both wedge pressure elevation (PAWP) and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis. We aimed at describing the different haemodynamic phenotypes of patients with PH due to left heart disease (LHD) and at characterizing the impact of pulmonary haemodynamics on RV function and outcome PH-LHD.
Patients with PH-LHD were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n = 35). PH-LHD patients were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG3 WU, n = 27), and "intermediate" PH-LHD (either DPG |
| doi_str_mv | 10.1371/journal.pone.0199164 |
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Patients with PH-LHD were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n = 35). PH-LHD patients were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG<7 mmHg and pulmonary vascular resistance, PVR≤3 WU, n = 37), Combined post- and pre-capillary PH (CpcPH: DPG≥7 mmHg and PVR>3 WU, n = 27), and "intermediate" PH-LHD (either DPG <7 mmHg or PVR ≤3 WU, n = 29).
Despite similar PAWP and cardiac index, haemodynamic severity and prevalence of RV dysfunction increased from IpcPH, to "intermediate" and CpcPH. PVR and DPG (but not compliance, Ca) were linearly correlated with RV dysfunction. CpcPH had worse prognosis (p<0.05) than IpcPH and PAH, but similar to "intermediate" patients. Only NTproBNP and Ca independently predicted survival in PH-LHD.
In PH-LHD, haemodynamic characterization according to DPG and PVR provides important information on disease severity, predisposition to RV failure and prognosis. Patients presenting the CpcPH phenotype appear to have haemodynamic profile closer to PAH but with worse prognosis. In PH-LHD, Ca and NTproBNP were independent predictors of survival.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0199164</identifier><identifier>PMID: 29920539</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Analysis ; Biology and Life Sciences ; Biomarkers ; Blood pressure ; Calcium - blood ; Capillaries - physiopathology ; Capillary pressure ; Cardiac Catheterization ; Cardiology ; Cardiovascular disease ; Chronic obstructive pulmonary disease ; Complications and side effects ; Coronary artery disease ; Diastolic pressure ; Endothelium, Vascular - physiopathology ; Female ; Heart ; Heart diseases ; Heart failure ; Heart Failure - etiology ; Heart Failure - physiopathology ; Heart Ventricles - physiopathology ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary - etiology ; Hypertension, Pulmonary - mortality ; Hypertension, Pulmonary - physiopathology ; Kaplan-Meier Estimate ; Lung diseases ; Male ; Medical imaging ; Medical prognosis ; Medicine and Health Sciences ; Metabolism ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Patients ; Peptide Fragments - blood ; Phenotype ; Phenotypes ; Prognosis ; Proportional Hazards Models ; Pulmonary arteries ; Pulmonary hypertension ; Pulmonary Wedge Pressure ; Retrospective Studies ; Risk factors ; Survival ; Treatment Outcome ; Vascular Resistance ; Vasoconstriction ; Veins & arteries ; Ventricle ; Ventricular Dysfunction, Left - blood ; Ventricular Dysfunction, Left - complications</subject><ispartof>PloS one, 2018-06, Vol.13 (6), p.e0199164-e0199164</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Caravita et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Caravita et al 2018 Caravita et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-fc21be1dd188e067fafc92894eb09f783367220a648e8b2c4e86919d708266243</citedby><cites>FETCH-LOGICAL-c758t-fc21be1dd188e067fafc92894eb09f783367220a648e8b2c4e86919d708266243</cites><orcidid>0000-0001-9402-7439 ; 0000-0002-3003-6499 ; 0000-0002-8924-8234</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007912/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007912/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29920539$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lionetti, Vincenzo</contributor><creatorcontrib>Caravita, Sergio</creatorcontrib><creatorcontrib>Faini, Andrea</creatorcontrib><creatorcontrib>Carolino D'Araujo, Sandy</creatorcontrib><creatorcontrib>Dewachter, Céline</creatorcontrib><creatorcontrib>Chomette, Laura</creatorcontrib><creatorcontrib>Bondue, Antoine</creatorcontrib><creatorcontrib>Naeije, Robert</creatorcontrib><creatorcontrib>Parati, Gianfranco</creatorcontrib><creatorcontrib>Vachiéry, Jean-Luc</creatorcontrib><title>Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: Role of the pre-capillary component</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In pulmonary hypertension (PH), both wedge pressure elevation (PAWP) and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis. We aimed at describing the different haemodynamic phenotypes of patients with PH due to left heart disease (LHD) and at characterizing the impact of pulmonary haemodynamics on RV function and outcome PH-LHD.
Patients with PH-LHD were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n = 35). PH-LHD patients were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG<7 mmHg and pulmonary vascular resistance, PVR≤3 WU, n = 37), Combined post- and pre-capillary PH (CpcPH: DPG≥7 mmHg and PVR>3 WU, n = 27), and "intermediate" PH-LHD (either DPG <7 mmHg or PVR ≤3 WU, n = 29).
Despite similar PAWP and cardiac index, haemodynamic severity and prevalence of RV dysfunction increased from IpcPH, to "intermediate" and CpcPH. PVR and DPG (but not compliance, Ca) were linearly correlated with RV dysfunction. CpcPH had worse prognosis (p<0.05) than IpcPH and PAH, but similar to "intermediate" patients. Only NTproBNP and Ca independently predicted survival in PH-LHD.
In PH-LHD, haemodynamic characterization according to DPG and PVR provides important information on disease severity, predisposition to RV failure and prognosis. Patients presenting the CpcPH phenotype appear to have haemodynamic profile closer to PAH but with worse prognosis. In PH-LHD, Ca and NTproBNP were independent predictors of survival.</description><subject>Adult</subject><subject>Aged</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Biomarkers</subject><subject>Blood pressure</subject><subject>Calcium - blood</subject><subject>Capillaries - physiopathology</subject><subject>Capillary pressure</subject><subject>Cardiac Catheterization</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Chronic obstructive pulmonary disease</subject><subject>Complications and side effects</subject><subject>Coronary artery disease</subject><subject>Diastolic pressure</subject><subject>Endothelium, Vascular - physiopathology</subject><subject>Female</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure - etiology</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension, Pulmonary - etiology</subject><subject>Hypertension, Pulmonary - mortality</subject><subject>Hypertension, Pulmonary - physiopathology</subject><subject>Kaplan-Meier Estimate</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Medicine and Health Sciences</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Patients</subject><subject>Peptide Fragments - blood</subject><subject>Phenotype</subject><subject>Phenotypes</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary arteries</subject><subject>Pulmonary hypertension</subject><subject>Pulmonary Wedge Pressure</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Survival</subject><subject>Treatment Outcome</subject><subject>Vascular Resistance</subject><subject>Vasoconstriction</subject><subject>Veins & arteries</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Left - 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blood</topic><topic>Capillaries - physiopathology</topic><topic>Capillary pressure</topic><topic>Cardiac Catheterization</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Chronic obstructive pulmonary disease</topic><topic>Complications and side effects</topic><topic>Coronary artery disease</topic><topic>Diastolic pressure</topic><topic>Endothelium, Vascular - physiopathology</topic><topic>Female</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart Failure - etiology</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Ventricles - physiopathology</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension, Pulmonary - etiology</topic><topic>Hypertension, Pulmonary - mortality</topic><topic>Hypertension, Pulmonary - physiopathology</topic><topic>Kaplan-Meier Estimate</topic><topic>Lung diseases</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Medicine and Health Sciences</topic><topic>Metabolism</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Patients</topic><topic>Peptide Fragments - blood</topic><topic>Phenotype</topic><topic>Phenotypes</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary arteries</topic><topic>Pulmonary hypertension</topic><topic>Pulmonary Wedge Pressure</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Survival</topic><topic>Treatment Outcome</topic><topic>Vascular Resistance</topic><topic>Vasoconstriction</topic><topic>Veins & arteries</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Left - blood</topic><topic>Ventricular Dysfunction, Left - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caravita, Sergio</creatorcontrib><creatorcontrib>Faini, Andrea</creatorcontrib><creatorcontrib>Carolino D'Araujo, Sandy</creatorcontrib><creatorcontrib>Dewachter, Céline</creatorcontrib><creatorcontrib>Chomette, Laura</creatorcontrib><creatorcontrib>Bondue, Antoine</creatorcontrib><creatorcontrib>Naeije, Robert</creatorcontrib><creatorcontrib>Parati, Gianfranco</creatorcontrib><creatorcontrib>Vachiéry, Jean-Luc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caravita, Sergio</au><au>Faini, Andrea</au><au>Carolino D'Araujo, Sandy</au><au>Dewachter, Céline</au><au>Chomette, Laura</au><au>Bondue, Antoine</au><au>Naeije, Robert</au><au>Parati, Gianfranco</au><au>Vachiéry, Jean-Luc</au><au>Lionetti, Vincenzo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: Role of the pre-capillary component</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-06-19</date><risdate>2018</risdate><volume>13</volume><issue>6</issue><spage>e0199164</spage><epage>e0199164</epage><pages>e0199164-e0199164</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In pulmonary hypertension (PH), both wedge pressure elevation (PAWP) and a precapillary component may affect right ventricular (RV) afterload. These changes may contribute to RV failure and prognosis. We aimed at describing the different haemodynamic phenotypes of patients with PH due to left heart disease (LHD) and at characterizing the impact of pulmonary haemodynamics on RV function and outcome PH-LHD.
Patients with PH-LHD were compared with treatment-naïve idiopathic/heritable pulmonary arterial hypertension (PAH, n = 35). PH-LHD patients were subdivided in Isolated post-capillary PH (IpcPH: diastolic pressure gradient, DPG<7 mmHg and pulmonary vascular resistance, PVR≤3 WU, n = 37), Combined post- and pre-capillary PH (CpcPH: DPG≥7 mmHg and PVR>3 WU, n = 27), and "intermediate" PH-LHD (either DPG <7 mmHg or PVR ≤3 WU, n = 29).
Despite similar PAWP and cardiac index, haemodynamic severity and prevalence of RV dysfunction increased from IpcPH, to "intermediate" and CpcPH. PVR and DPG (but not compliance, Ca) were linearly correlated with RV dysfunction. CpcPH had worse prognosis (p<0.05) than IpcPH and PAH, but similar to "intermediate" patients. Only NTproBNP and Ca independently predicted survival in PH-LHD.
In PH-LHD, haemodynamic characterization according to DPG and PVR provides important information on disease severity, predisposition to RV failure and prognosis. Patients presenting the CpcPH phenotype appear to have haemodynamic profile closer to PAH but with worse prognosis. In PH-LHD, Ca and NTproBNP were independent predictors of survival.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>29920539</pmid><doi>10.1371/journal.pone.0199164</doi><tpages>e0199164</tpages><orcidid>https://orcid.org/0000-0001-9402-7439</orcidid><orcidid>https://orcid.org/0000-0002-3003-6499</orcidid><orcidid>https://orcid.org/0000-0002-8924-8234</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-06, Vol.13 (6), p.e0199164-e0199164 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2057060739 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Analysis Biology and Life Sciences Biomarkers Blood pressure Calcium - blood Capillaries - physiopathology Capillary pressure Cardiac Catheterization Cardiology Cardiovascular disease Chronic obstructive pulmonary disease Complications and side effects Coronary artery disease Diastolic pressure Endothelium, Vascular - physiopathology Female Heart Heart diseases Heart failure Heart Failure - etiology Heart Failure - physiopathology Heart Ventricles - physiopathology Hemodynamics Humans Hypertension Hypertension, Pulmonary - etiology Hypertension, Pulmonary - mortality Hypertension, Pulmonary - physiopathology Kaplan-Meier Estimate Lung diseases Male Medical imaging Medical prognosis Medicine and Health Sciences Metabolism Middle Aged Natriuretic Peptide, Brain - blood Patients Peptide Fragments - blood Phenotype Phenotypes Prognosis Proportional Hazards Models Pulmonary arteries Pulmonary hypertension Pulmonary Wedge Pressure Retrospective Studies Risk factors Survival Treatment Outcome Vascular Resistance Vasoconstriction Veins & arteries Ventricle Ventricular Dysfunction, Left - blood Ventricular Dysfunction, Left - complications |
| title | Clinical phenotypes and outcomes of pulmonary hypertension due to left heart disease: Role of the pre-capillary component |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T15%3A48%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20phenotypes%20and%20outcomes%20of%20pulmonary%20hypertension%20due%20to%20left%20heart%20disease:%20Role%20of%20the%20pre-capillary%20component&rft.jtitle=PloS%20one&rft.au=Caravita,%20Sergio&rft.date=2018-06-19&rft.volume=13&rft.issue=6&rft.spage=e0199164&rft.epage=e0199164&rft.pages=e0199164-e0199164&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0199164&rft_dat=%3Cgale_plos_%3EA543555974%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2057060739&rft_id=info:pmid/29920539&rft_galeid=A543555974&rft_doaj_id=oai_doaj_org_article_5b5bc87250a94a5d9d14c088a6ac82f6&rfr_iscdi=true |