Pulmonary hypertension due to left heart disease: analysis of survival according to the haemodynamic classification of the 2015 ESC/ERS guidelines and insights for future changes

Aims Pulmonary hypertension (PH) is a relevant complication of left heart disease (LHD). The 2015 ESC/ERS PH guidelines report two different haemodynamic subsets of PH due to LHD (PH‐LHD) based on levels of pulmonary vascular resistance (PVR) and diastolic pressure gradient (DPG): isolated post‐capillary PH (Ipc‐PH) and combined post‐ and pre‐capillary PH (Cpc‐PH). The objective of this study is to evaluate the prognostic value of Ipc‐PH and Cpc‐PH. Methods and results Data from 276 consecutive incident patients with PH‐LHD were included. According to the guidelines, Ipc‐PH is defined by DPG 3 WU. Using this definition, we identified three patient groups: Ipc‐PH with both normal PVR and DPG (108 patients); Cpc‐PH with both increased PVR and DPG (66 patients); and an intermediate group with either increased PVR or DPG (102 patients). Survival was estimated using the Kaplan–Meier method and compared between groups using the log‐rank test. Patients with Ipc‐PH had better survival compared with the group of patients with Cpc‐PH (P = 0.026) and the intermediate group (P = 0.025). No survival difference was detected between patients with Cpc‐PH and the intermediate group (P = 0.891). Patients with normal PVR had a better survival compared with those with elevated PVR (P = 0.012); while no difference was observed according to the level of DPG (P = 0.253). Conclusion Patients with Ipc‐PH have a better prognosis compared with patients with Cpc‐PH and with patients with isolated increase of PVR or DPG. Pulmonary vascular resistance has a better predictive value than DPG in patients with PH‐LHD.