Outcomes in World Health Organization Group II Pulmonary Hypertension: Mortality and Readmission Trends With Systolic and Preserved Ejection Fraction–Induced Pulmonary Hypertension

• Published in: Journal of cardiac failure 2014-07, Vol.20 (7), p.467-475
• Main Authors: Salamon, Jason N., MD, Kelesidis, Iosif, MD, MPH, Msaouel, Pavlos, MD, PhD, Mazurek, Jeremy A., MD, Mannem, Santhosh, MD, Adzic, Aleksandar, MD, Zolty, Ronald, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Cohort Studies; diastolic dysfunction; Female; Heart Failure - diagnostic imaging; Heart Failure - mortality; Humans; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - mortality; Left heart failure; Male; Middle Aged; Mortality - trends; Patient Readmission - trends; pulmonary hypertension; Stroke Volume - physiology; Systole - physiology; Treatment Outcome; Ultrasonography; World Health Organization
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2014.05.003

Abstract Background Heart failure with preserved ejection fraction (HFpEF) has been increasingly recognized as a leading cause of pulmonary hypertension (HFpEF-PH). It remains unknown how HFpEF-PH fares in relation to systolic HF (reduced ejection fraction)–induced PH (HFrEF-PH). Therefore, we sought to determine the long-term morbidity and mortality of HFpEF-PH and HFrEF-PH. Methods and Results We studied all patients over a 6-year period with symptomatic HF and severe PH (PASP ≥65 mm Hg) in The Bronx, New York. We classified patients as having either preserved (≥50%) or reduced (≤35%) left ventricular ejection fraction. Trends in mortality and HF readmission rates were defined in 650 patients (HFrEF-PH: n = 277; HFpEF-PH: n = 373). HFpEF-PH patients were older and more often female and white. HFrEF-PH patients were more often black, had ischemic cardiomyopathy, and were on typical HF drug regimens. Patients with HFpEF-PH had a significantly increased all-cause 5-year mortality (52% vs 42%; P  = .024). HFpEF-PH was a significant predictor of mortality (adjusted hazard ratio 1.70; P  = .012). Patients with HFrEF-PH had more HF readmissions (≥1) than patients with HFpEF-PH (28.6% vs 15%; P  = .003), especially within the 1st year (9.1% vs 1.7%; P  = .005). Conclusions Patients with HFrEF-PH and HFpEF-PH have a significantly elevated long-term mortality, with HFpEF-PH having a higher 5-year mortality rate. These findings testify to the overall poor prognosis of World Health Organization Group II PH, especially HFpEF-PH.