CORRESPONDENCE: LETTER TO THE EDITOR
Pulmonary Hypertension in Heart Failure With Preserved Ejection FractionAny Pathophysiological Role of Mitral Regurgitation
Marco Guazzi, MD, PhD*
* Cardiopulmonary Unit, University of Milano, San Paolo Hospital, Via A di Rudinì, 8, 20142 Milano, Italy
I read with interest the study by Lam et al. (1) as an important contribution to the pathophysiological and clinical impact of pulmonary hypertension (PH) in hypertensive patients with heart failure and preserved left ventricular ejection fraction (HFpEF). Recent guidelines on arterial PH recognize HFpEF as a growing cause of left-sided PH (2), but a definitive appreciation of its true prevalence and prognostic relevance is lacking. The present study provides some new important information on this subject.
It is noteworthy that HFpEF was associated, in a high rate of cases (83%), with a typical hemodynamic pattern of pre-capillary PH, and a strong correlation was found between pulmonary artery systolic pressure and pulmonary capillary wedge pressure. Most important, pulmonary artery systolic pressure, rather than other echocardiography-derived measures of diastolic dysfunction, was the only significant multivariate predictor of mortality, a finding that was confirmed even when combined comorbid diseases potentially contributing to PH development, such as chronic obstructive pulmonary disease, were taken into account.
In patients with systolic heart failure, a major determinant of PH development is mitral regurgitation (3,4). Whether mitral regurgitation could be a putative factor in the pathogenesis of PH in HFpEF patients remains an open and intriguing question. Accordingly, it would be of interest if the authors could provide some details on how many HFpEF patients exhibited mitral regurgitation, especially in comparison with control hypertensive patients without HFpEF. Definitive appreciation of the relative pathophysiological role of mitral insufficiency in the PH development and severity may predictably represent a step forward in the progressive fascinating characterization of HFpEF patients.
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1. Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study J Am Coll Cardiol 2009;53:1119-1123.[Abstract/Free Full Text]2. McLaughlin VV, Archer SL, Badesch DB, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association, developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association J Am Coll Cardiol 2009;53:1573-1619.[Free Full Text] 3. Enriquez-Sarano M, Rossi A, Seward J, Bailey K, Tajik J. Determinants of pulmonary hypertension in left ventricular dysfunction J Am Coll Cardiol 1997;29:153-159.[Abstract] 4. Tumminello G, Lancellotti P, Lempereur M, D'Orio V, Pierard LA. Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure Eur Heart J 2007;28:569-574.[Abstract/Free Full Text]
Related Article
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- Carolyn S.P. Lam and Margaret M. Redfield
J. Am. Coll. Cardiol. 2009 54: 1192.
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