Analysis of echocardiographic parameters suggestive of pulmonary hypertension in patients with heart failure with preserved ejection fraction and assessment of clinical features favoring development of the PH-phenotype

Abstract

Introduction: Heart failure with preserved ejection fraction (HFpEF) is characterized by left ventricle (LV) diastolic dysfunction. Impaired diastolic function induces pulmonary congestion and leads to postcapillary pulmonary hypertension (PH), which is an important contributor to clinical deterioration and increased mortality. Material and methods: A retrospective one-centre analysis of 63 consecutive patients hospitalized due to HFpEF was performed. The study group was divided according to the echocardiographic probability of PH using tricuspid regurgitation peak velocity (TRV) into two groups: TRV ≥ 2.8 m/s – with an increased probability of PH (n = 15 (23.8%); females: 3 (20%); mean age 72.7 ± 10.8) and TRV < 2.8 m/s – with a low probability of PH (n = 48 (76.2%); females: 25 (52.1%); mean age 72.3 ± 13.7). The clinical data, transthoracic echocardiography (TTE) parameters and laboratory tests were analyzed. Results: The group of patients with an increased probability of PH was characterized by more severe HF symptoms, more frequent fatigue (p = 0.03) and the occurrence of ankle swelling (p < 0.01). Analysis of the baseline data revealed a trend towards a greater incidence of atrial fibrillation (AF; p = 0.08) in this group. The patients who had TRV ≥ 2.8 m/s had a larger left atrial area (p < 0.001), a higher E/A ratio (p < 0.001) with borderline differences in the left ventricular mass index (LVMI; p = 0.06) and left ventricular ejection fraction (LVEF; p = 0.07). Conclusions: About 25% of patients with HFpEF, mostly males, present with moderate features of PH that are associated with more advanced LV and left atrium (LA) remodeling and dysfunction. However, they are not reflected in the classic comorbidities, with the exception of AF.

Keywords

• heart failure
• heart failure with preserved ejection fraction
• postcapillary pulmonary hypertension
• chronic atrial fibrillation