Advertisement

Click here for more guidelines.
2012 ACCF/ AATS/ SCAI/ STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
ACCF/ SCAI/ STS/ AATS/ AHA/ ASNC/ HFSA/ SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
2012 ACCF/ AHA/ ACR/ SCAI/ SIR/ STS/ SVM/ SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

 
About JACC CME
Policy on Privacy and Confidentiality
Disclosures
Important Information
 

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME
 
 

Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions
 
 

About the Journal
Editorial Board & Staff
 
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2009; 53:1119-1126, doi:10.1016/j.jacc.2008.11.051
© 2009 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (19)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lam, C. S.P.
Right arrow Articles by Redfield, M. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lam, C. S.P.
Right arrow Articles by Redfield, M. M.
Related Collections
Right arrowRelated Articles

CLINICAL RESEARCH: HEART FAILURE

Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction

A Community-Based Study

Carolyn S.P. Lam, MBBS*,{dagger}, Véronique L. Roger, MD, MPH*, Richard J. Rodeheffer, MD*, Barry A. Borlaug, MD*, Felicity T. Enders, PhD{ddagger} and Margaret M. Redfield, MD*,*

* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
{dagger} Yong Loo Lin School of Medicine, Singapore, Singapore
{ddagger} Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota

Manuscript received August 20, 2008; revised manuscript received November 17, 2008, accepted November 30, 2008.

* Reprint requests and correspondence: Dr. Margaret M. Redfield, 200 First Street SW, Rochester, Minnesota 55905 (Email: redfield.margaret{at}mayo.edu).

Objectives: This study sought to define the prevalence, severity, and significance of pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) in the general community.

Background: Although HFpEF is known to cause PH, its development is highly variable. Community-based data are lacking, and the relative contribution of pulmonary venous versus pulmonary arterial hypertension (HTN) to PH in HFpEF is unknown. We hypothesized that PH would be a marker of symptomatic pulmonary congestion, distinguishing HFpEF from pre-clinical hypertensive heart disease.

Methods: This community-based study of 244 HFpEF patients (age 76 ± 13 years; 45% male) was followed up using Doppler echocardiography over 3 years. Control subjects were 719 adults with HTN without HF (age 66 ± 10 years; 44% male). Pulmonary artery systolic pressure (PASP) was derived from the tricuspid regurgitation velocity and PH defined as PASP >35 mm Hg. Pulmonary capillary wedge pressure (PCWP) was estimated from the ratio of early transmitral flow velocity to early mitral annular diastolic velocity.

Results: In HFpEF, PH was present in 83% and the median (25th, 75th percentile) PASP was 48 (37, 56) mm Hg. PASP increased with PCWP (r = 0.21; p < 0.007). Adjusting for PCWP, PASP was higher in HFpEF than HTN (p < 0.001). The PASP distinguished HFpEF from HTN with an area under the receiver-operating characteristic curve of 0.91 (p < 0.001) and strongly predicted mortality in HFpEF (hazard ratio: 1.3 per 10 mm Hg; p < 0.001).

Conclusions: PH is highly prevalent and often severe in HFpEF. Although pulmonary venous HTN contributes to PH, it does not fully account for the severity of PH in HFpEF, suggesting that a component of pulmonary arterial HTN also contributes. The potent effect of PASP on mortality lends support for therapies aimed at pulmonary arterial HTN in HFpEF.

Key Words: pulmonary hypertension • diastolic heart failure • heart failure with preserved ejection fraction

Abbreviations and Acronyms
  AUC = area under the curve
  COPD = chronic obstructive pulmonary disease
  EF = ejection fraction
  HF = heart failure
  HFpEF = heart failure with preserved ejection fraction
  HTN = hypertension
  PASP = pulmonary artery systolic pressure
  PCWP = pulmonary capillary wedge pressure
  PH = pulmonary hypertension
  TR = tricuspid regurgitation


Related Articles

The Role of the Pulmonary Vasculature in Heart Failure With Preserved Ejection Fraction
Gregory D. Lewis
J. Am. Coll. Cardiol. 2009 53: 1127-1129. [Full Text] [PDF]

Inside This Issue
J. Am. Coll. Cardiol. 2009 53: A24. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
C. C. Welles, I. A. Ku, D. M. Kwan, M. A. Whooley, N. B. Schiller, and M. P. Turakhia
Left Atrial Function Predicts Heart Failure Hospitalization in Subjects With Preserved Ejection Fraction and Coronary Heart Disease: Longitudinal Data From the Heart and Soul Study
J. Am. Coll. Cardiol., February 14, 2012; 59(7): 673 - 680.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
B. R. Szwejkowski, D. H. J. Elder, F. Shearer, D. Jack, A. M. J. Choy, S. D. Pringle, A. D. Struthers, J. George, and C. C. Lang
Pulmonary hypertension predicts all-cause mortality in patients with heart failure: a retrospective cohort study
Eur J Heart Fail, February 1, 2012; 14(2): 162 - 167.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Schwartzenberg, M. M. Redfield, A. M. From, P. Sorajja, R. A. Nishimura, and B. A. Borlaug
Effects of Vasodilation in Heart Failure With Preserved or Reduced Ejection Fraction: Implications of Distinct Pathophysiologies on Response to Therapy
J. Am. Coll. Cardiol., January 31, 2012; 59(5): 442 - 451.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
E. Donal, C. Thebault, L. H. Lund, G. Kervio, A. Reynaud, T. Simon, E. Drouet, E. Nonotte, C. Linde, and J.-C. Daubert
Heart failure with a preserved ejection fraction additive value of an exercise stress echocardiography
Eur Heart J Cardiovasc Imaging, January 29, 2012; (2012) jes010v1.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
F. Bursi, S. M. McNallan, M. M. Redfield, V. T. Nkomo, C. S. P. Lam, S. A. Weston, R. Jiang, and V. L. Roger
Pulmonary Pressures and Death in Heart Failure: A Community Study
J. Am. Coll. Cardiol., January 17, 2012; 59(3): 222 - 231.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. H. Park and M. R. Mehra
Pulmonary Hypertension: The Great Leveler
J. Am. Coll. Cardiol., January 17, 2012; 59(3): 232 - 234.
[Full Text] [PDF]

Home page
 CirculationHome page
M. R. Zile, J. S. Gottdiener, S. J. Hetzel, J. J. McMurray, M. Komajda, R. McKelvie, C. F. Baicu, B. M. Massie, P. E. Carson, and for the I-PRESERVE Investigators
Prevalence and Significance of Alterations in Cardiac Structure and Function in Patients With Heart Failure and a Preserved Ejection Fraction
Circulation, December 6, 2011; 124(23): 2491 - 2501.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. Ghoreishi, C. F. Evans, C. R. DeFilippi, G. Hobbs, C. A. Young, B. P. Griffith, and J. S. Gammie
Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing of surgery
J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1439 - 1452.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
T. Damy, A. Kallvikbacka-Bennett, J. Zhang, K. Goode, L. Buga, J. Hobkirk, A. Yassin, J.-L. Dubois-Rande, L. Hittinger, J. G. F. Cleland, et al.
Does the physical examination still have a role in patients with suspected heart failure?
Eur J Heart Fail, December 1, 2011; 13(12): 1340 - 1348.
[Abstract] [Full Text] [PDF]

Home page
 Circ Heart FailHome page
N. A. Chatterjee and G. D. Lewis
What Is the Prognostic Significance of Pulmonary Hypertension in Heart Failure?
Circ Heart Fail, September 1, 2011; 4(5): 541 - 545.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
D. Aronson, A. Eitan, R. Dragu, and A. J. Burger
Relationship Between Reactive Pulmonary Hypertension and Mortality in Patients With Acute Decompensated Heart Failure
Circ Heart Fail, September 1, 2011; 4(5): 644 - 650.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
J. Meluzin, J. Sitar, J. Kristek, R. Prosecky, M. Pesl, H. Podrouzkova, V. Soska, R. Panovsky, and L. Dusek
The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction
Eur Heart J Cardiovasc Imaging, August 1, 2011; 12(8): 591 - 602.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
A. B. Waxman
Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: A Target for Therapy?
Circulation, July 12, 2011; 124(2): 133 - 135.
[Full Text] [PDF]

Home page
 CirculationHome page
M. Guazzi, M. Vicenzi, R. Arena, and M. D. Guazzi
Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: A Target of Phosphodiesterase-5 Inhibition in a 1-Year Study
Circulation, July 12, 2011; 124(2): 164 - 174.
[Abstract] [Full Text] [PDF]

Home page
 Eur Respir JHome page
D. Montani and I. M. Lang
Mast cells: bridging the gap between pre- and post-capillary pulmonary hypertension?
Eur. Respir. J., June 1, 2011; 37(6): 1303 - 1305.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
J. Hoffmann, J. Yin, M. Kukucka, N. Yin, I. Saarikko, A. Sterner-Kock, H. Fujii, H. Leong-Poi, H. Kuppe, R. T. Schermuly, et al.
Mast cells promote lung vascular remodelling in pulmonary hypertension
Eur. Respir. J., June 1, 2011; 37(6): 1400 - 1410.
[Abstract] [Full Text] [PDF]

Home page
 Mayo Clin Proc.Home page
G. O. Oghlakian, I. Sipahi, and J. C. Fang
Treatment of Heart Failure With Preserved Ejection Fraction: Have We Been Pursuing the Wrong Paradigm?
Mayo Clin. Proc., June 1, 2011; 86(6): 531 - 539.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. T. Cole, A. P. Kalogeropoulos, V. V. Georgiopoulou, M. Gheorghiade, A. Quyyumi, C. Yancy, and J. Butler
Hydralazine and Isosorbide Dinitrate in Heart Failure: Historical Perspective, Mechanisms, and Future Directions
Circulation, May 31, 2011; 123(21): 2414 - 2422.
[Full Text] [PDF]

Home page
 CirculationHome page
B. A. Borlaug and M. M. Redfield
Diastolic and Systolic Heart Failure Are Distinct Phenotypes Within the Heart Failure Spectrum
Circulation, May 10, 2011; 123(18): 2006 - 2014.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
B. A. Borlaug
Discerning Pulmonary Venous From Pulmonary Arterial Hypertension Without the Help of a Catheter
Circ Heart Fail, May 1, 2011; 4(3): 235 - 237.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
N. S. Hill, I. Preston, and K. Roberts
Defining the Phenotypes for Pulmonary Hypertension Associated With Diastolic Heart Failure
Circ Heart Fail, May 1, 2011; 4(3): 238 - 240.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
K. Chatterjee
Response to Campbell: Is This a Case of Constriction?
Circ Heart Fail, May 1, 2011; 4(3): 374 - 377.
[Full Text] [PDF]

Home page
 Circ Heart FailHome page
T. Thenappan, S. J. Shah, M. Gomberg-Maitland, B. Collander, A. Vallakati, P. Shroff, and S. Rich
Clinical Characteristics of Pulmonary Hypertension in Patients With Heart Failure and Preserved Ejection Fraction
Circ Heart Fail, May 1, 2011; 4(3): 257 - 265.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
B. A. Borlaug
Reply
J. Am. Coll. Cardiol., March 29, 2011; 57(13): 1499 - 1500.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
B. A. Borlaug and W. J. Paulus
Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment
Eur. Heart J., March 2, 2011; 32(6): 670 - 679.
[Abstract] [Full Text] [PDF]

Home page
 Circ Heart FailHome page
J. Yin, M. Kukucka, J. Hoffmann, A. Sterner-Kock, J. Burhenne, W. E. Haefeli, H. Kuppe, and W. M. Kuebler
Sildenafil Preserves Lung Endothelial Function and Prevents Pulmonary Vascular Remodeling in a Rat Model of Diastolic Heart Failure
Circ Heart Fail, March 1, 2011; 4(2): 198 - 206.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. H. Drazner
The Progression of Hypertensive Heart Disease
Circulation, January 25, 2011; 123(3): 327 - 334.
[Full Text] [PDF]

Home page
 Eur J Heart FailHome page
C. S. P. Lam, E. Donal, E. Kraigher-Krainer, and R. S. Vasan
Epidemiology and clinical course of heart failure with preserved ejection fraction
Eur J Heart Fail, January 1, 2011; 13(1): 18 - 28.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
B. Pieske
Heart failure with preserved ejection fraction--a growing epidemic or 'The Emperor's New Clothes?'
Eur J Heart Fail, January 1, 2011; 13(1): 11 - 13.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
I. M. Lang, C. Plank, R. Sadushi-Kolici, J. Jakowitsch, W. Klepetko, and G. Maurer
Imaging in Pulmonary Hypertension
J. Am. Coll. Cardiol. Img., December 1, 2010; 3(12): 1287 - 1295.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
G.-H. Yan, M. Wang, W.-S. Yue, K.-H. Yiu, C.-W. Siu, S. W. L. Lee, C.-P. Lau, and H.-F. Tse
Elevated pulmonary artery systolic pressure in patients with coronary artery disease and left ventricular dyssynchrony
Eur J Heart Fail, October 1, 2010; 12(10): 1067 - 1075.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. T. Maeder, B. R. Thompson, H.-P. Brunner-La Rocca, and D. M. Kaye
Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction
J. Am. Coll. Cardiol., September 7, 2010; 56(11): 855 - 863.
[Abstract] [Full Text] [PDF]

Home page
 Circ Heart FailHome page
B. A. Borlaug, R. A. Nishimura, P. Sorajja, C. S. P. Lam, and M. M. Redfield
Exercise Hemodynamics Enhance Diagnosis of Early Heart Failure With Preserved Ejection Fraction
Circ Heart Fail, September 1, 2010; 3(5): 588 - 595.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
C. S. P. Lam
Heart Failure With Preserved Ejection Fraction: Invasive Solution to Diagnostic Confusion?
J. Am. Coll. Cardiol., April 20, 2010; 55(16): 1711 - 1712.
[Full Text] [PDF]

Home page
 Circ. Res.Home page
A. Kerem, J. Yin, S. M. Kaestle, J. Hoffmann, A. M. Schoene, B. Singh, H. Kuppe, M. M. Borst, and W. M. Kuebler
Lung Endothelial Dysfunction in Congestive Heart Failure: Role of Impaired Ca2+ Signaling and Cytoskeletal Reorganization
Circ. Res., April 2, 2010; 106(6): 1103 - 1116.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
D. D Correa de Sa, D. O Hodge, J. P Slusser, M. M Redfield, R. D Simari, J. C Burnett, and H. H Chen
Progression of preclinical diastolic dysfunction to the development of symptoms
Heart, April 1, 2010; 96(7): 528 - 532.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W. J. Paulus and J. J.M. van Ballegoij
Treatment of Heart Failure With Normal Ejection Fraction: An Inconvenient Truth!
J. Am. Coll. Cardiol., February 9, 2010; 55(6): 526 - 537.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G. W.-K. Yip, M. Frenneaux, and J. E Sanderson
Heart failure with a normal ejection fraction: new developments
Heart, October 1, 2009; 95(19): 1549 - 1552.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. Guazzi
Pulmonary Hypertension in Heart Failure With Preserved Ejection Fraction: Any Pathophysiological Role of Mitral Regurgitation
J. Am. Coll. Cardiol., September 22, 2009; 54(13): 1191 - 1192.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
C. S.P. Lam and M. M. Redfield
Reply
J. Am. Coll. Cardiol., September 22, 2009; 54(13): 1192 - 1192.
[Full Text] [PDF]

Home page
 CirculationHome page
W. C. Little and J. K. Oh
Echocardiographic Evaluation of Diastolic Function Can Be Used to Guide Clinical Care
Circulation, September 1, 2009; 120(9): 802 - 809.
[Full Text] [PDF]

Home page
 CirculationHome page
C. Tschope and W. J. Paulus
Doppler Echocardiography Yields Dubious Estimates of Left Ventricular Diastolic Pressures
Circulation, September 1, 2009; 120(9): 810 - 820.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. T. Maeder and D. M. Kaye
Reply
J. Am. Coll. Cardiol., July 28, 2009; 54(5): 488 - 489.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. D. Lewis
The Role of the Pulmonary Vasculature in Heart Failure With Preserved Ejection Fraction
J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1127 - 1129.
[Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement