nach oben

Heart Failure Reviews

Erschienen in:

29.12.2015

Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction

verfasst von: Debra D. Dixon, Amar Trivedi, Sanjiv J. Shah

Erschienen in: Heart Failure Reviews | Ausgabe 3/2016

Einloggen, um Zugang zu erhalten

Abstract

Over 2.5 million patients in the USA suffer from heart failure with preserved ejection fraction (HFpEF), and pulmonary hypertension (PH) is present in the majority of these patients. PH represents an adverse prognostic factor in HFpEF and has been identified as a potential therapeutic target to improve symptoms and outcomes. The recognition and investigation of a subset of patients with superimposed pulmonary vascular disease (on top of pulmonary venous hypertension) has led to further subclassification of PH due to left heart disease (PH-LHD) into two categories: isolated post-capillary PH and combined post- and pre-capillary PH (CpcPH). In this review, we (1) describe the evolution of the diagnostic criteria of PH-LHD; (2) identify the diagnostic modalities that can be utilized for the identification of patients with CpcPH-HFpEF; (3) review the literature on the prevalence, clinical characteristics, and prognostic factors of CpcPH-HFpEF; (4) discuss recent and ongoing clinical trials investigating the effectiveness of selective pulmonary vasodilators in PH-LHD; and (5) propose future areas for further investigation of the etiology and pathophysiological mechanisms contributing to the development of CpcPH and highlight important considerations in the design of future trials to promote better characterization of this clinical entity. CpcPH-HFpEF is a distinct subset within HFpEF and one that may respond to targeted therapeutics.

Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128(16):1810–1852CrossRefPubMed

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB (2013) Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation 127(1):e6–e245CrossRefPubMed

Oktay AA, Rich JD, Shah SJ (2013) The emerging epidemic of heart failure with preserved ejection fraction. Curr Heart Fail Rep 10(4):401–410CrossRefPubMed

Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3):251–259CrossRefPubMed

Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol 53(13):1119–1126CrossRefPubMedPubMedCentral

Gerges M, Gerges C, Pistritto AMA, Lang MBM, Trip P, Jakowitsch J, Binder T, Lang IM (2015). Pulmonary hypertension in heart failure: epidemiology, right ventricular function and survival. Am J Respir Crit Care Med 192(10):1234–1246CrossRefPubMed

Kjaergaard J, Akkan D, Iversen KK, Kjoller E, Kober L, Torp-Pedersen C, Hassager C (2007) Prognostic importance of pulmonary hypertension in patients with heart failure. Am J Cardiol 99(8):1146–1150CrossRefPubMed

Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, Kalman J, Phillips RA, Steingart R, Brown EJ Jr, Berkowitz R, Moskowitz R, Soni A, Mancini D, Bijou R, Sehhat K, Varshneya N, Kukin M, Katz SD, Sleeper LA, Le Jemtel TH (2004) Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol 43(8):1432–1438CrossRefPubMed

Hernandez AF, Hammill BG, O’Connor CM, Schulman KA, Curtis LH, Fonarow GC (2009) Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol 53(2):184–192CrossRefPubMedPubMedCentral

10.

Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27(19):2338–2345CrossRefPubMed

11.

Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362(9386):777–781CrossRefPubMed

12.

Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR, Anderson S, Donovan M, Iverson E, Staiger C, Ptaszynska A (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359(23):2456–2467CrossRefPubMed

13.

Shah SJ (2013) Matchmaking for the optimization of clinical trials of heart failure with preserved ejection fraction: no laughing matter. J Am Coll Cardiol 62(15):1339–1342CrossRefPubMed

14.

McLaughlin VV, Shah SJ, Souza R, Humbert M (2015) Management of pulmonary arterial hypertension. J Am Coll Cardiol 65(18):1976–1997CrossRefPubMed

15.

Shah SJ (2012) Pulmonary hypertension. JAMA 308(13):1366–1374CrossRefPubMed

16.

Vachiery JL, Adir Y, Barbera JA, Champion H, Coghlan JG, Cottin V, De Marco T, Galie N, Ghio S, Gibbs JS, Martinez F, Semigran M, Simonneau G, Wells A, Seeger W (2013) Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol 62(25 Suppl):D100–D108CrossRefPubMed

17.

Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30(20):2493–2537CrossRefPubMed

18.

McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, Mathier MA, McGoon MD, Park MH, Rosenson RS, Rubin LJ, Tapson VF, Varga J, Harrington RA, Anderson JL, Bates ER, Bridges CR, Eisenberg MJ, Ferrari VA, Grines CL, Hlatky MA, Jacobs AK, Kaul S, Lichtenberg RC, Lindner JR, Moliterno DJ, Mukherjee D, Pohost GM, Rosenson RS, Schofield RS, Shubrooks SJ, Stein JH, Tracy CM, Weitz HH, Wesley DJ (2009) 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 Associati. Circulation 119(16):2250–2294CrossRefPubMed

19.

Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M, Denton CP, Elliott CG, Gaine SP, Gladwin MT, Jing Z-C, Krowka MJ, Langleben D, Nakanishi N, Souza R (2009) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 54(1 Suppl):43–54CrossRef

20.

Oudiz RJ (2007). Pulmonary hypertension associated with left-sided heart disease. Clin Chest Med 28(1):233–241, x

21.

Delgado JF, Conde E, Sanchez V, Lopez-Rios F, Gomez-Sanchez MA, Escribano P, Sotelo T, Gomez de la Camara A, Cortina J, de la Calzada CS (2005) Pulmonary vascular remodeling in pulmonary hypertension due to chronic heart failure. Eur J Heart Fail 7(6):1011–1016CrossRefPubMed

22.

Dixon DD, Cogswell R, Burke MA, Cuttica MJ, Freed BH, Beussink-Nelson L, Thenappan T, Shah SJ (2015) A non-invasive risk score for the prediction of combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction [abstract]. J Heart Lung Transplant 34(4):S118CrossRef

23.

Gerges C, Gerges M, Lang MB, Zhang Y, Jakowitsch J, Probst P, Maurer G, Lang IM (2013) Diastolic pulmonary vascular pressure gradient: a predictor of prognosis in “out-of-proportion” pulmonary hypertension. Chest 143(3):758–766CrossRefPubMed

24.

Naeije R, Vachiery JL, Yerly P, Vanderpool R (2013) The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease. Eur Respir J 41(1):217–223CrossRefPubMed

25.

Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M (2015). 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. doi:10.1093/eurheartj/ehv317

26.

Shah SJ, Katz DH, Deo RC (2014) Phenotypic spectrum of heart failure with preserved ejection fraction. Heart Fail Clin 10(3):407–418CrossRefPubMedPubMedCentral

27.

Tampakakis E, Leary PJ, Selby VN, De Marco T, Cappola TP, Felker MG, Russell SD, Kasper EK, Tedford RJ (2015) The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail 3(1):9–16CrossRefPubMedPubMedCentral

28.

Harvey RM, Enson Y, Ferrer MI (1971) A reconsideration of the origins of pulmonary hypertension. Chest 59(1):82–94CrossRefPubMed

29.

Ryan JJ, Rich JD, Thiruvoipati T, Swamy R, Kim GH, Rich S (2012) Current practice for determining pulmonary capillary wedge pressure predisposes to serious errors in the classification of patients with pulmonary hypertension. Am Heart J 163(4):589–594CrossRefPubMed

30.

Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB (2013) Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62(25 Suppl):D42–D50CrossRefPubMed

31.

Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, Redfield MM (2009) Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 119(20):2663–2670CrossRefPubMedPubMedCentral

32.

Rich JD, Shah SJ, Swamy RS, Kamp A, Rich S (2011) Inaccuracy of Doppler echocardiographic estimates of pulmonary artery pressures in patients with pulmonary hypertension: implications for clinical practice. Chest 139(5):988–993CrossRefPubMed

33.

Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J, Nikitin NP, Dubois-Rande JL, Hittinger L, Clark AL, Cleland JG (2012) Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail 18(3):216–225CrossRefPubMed

34.

Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, Temporelli PL, Arena R (2013) Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 305(9):H1373–H1381CrossRefPubMed

35.

Arkles JS, Opotowsky AR, Ojeda J, Rogers F, Liu T, Prassana V, Marzec L, Palevsky HI, Ferrari VA, Forfia PR (2011) Shape of the right ventricular Doppler envelope predicts hemodynamics and right heart function in pulmonary hypertension. Am J Respir Crit Care Med 183(2):268–276CrossRefPubMed

36.

Packer M, McMurray J, Massie BM, Caspi A, Charlon V, Cohen-Solal A, Kiowski W, Kostuk W, Krum H, Levine B, Rizzon P, Soler J, Swedberg K, Anderson S, Demets DL (2005) Clinical effects of endothelin receptor antagonism with bosentan in patients with severe chronic heart failure: results of a pilot study. J Card Fail 11(1):12–20CrossRefPubMed

37.

Kalra PR, Moon JC, Coats AJ (2002) Do results of the ENABLE (endothelin antagonist bosentan for lowering cardiac events in heart failure) study spell the end for non-selective endothelin antagonism in heart failure? Int J Cardiol 85(2–3):195–197CrossRefPubMed

38.

Luscher TF, Enseleit F, Pacher R, Mitrovic V, Schulze MR, Willenbrock R, Dietz R, Rousson V, Hurlimann D, Philipp S, Notter T, Noll G, Ruschitzka F (2002) Hemodynamic and neurohumoral effects of selective endothelin A (ET(A)) receptor blockade in chronic heart failure: the heart failure ET(A) receptor blockade trial (HEAT). Circulation 106(21):2666–2672CrossRefPubMed

39.

Califf RM, Adams KF, McKenna WJ, Gheorghiade M, Uretsky BF, McNulty SE, Darius H, Schulman K, Zannad F, Handberg-Thurmond E, Harrell FE Jr, Wheeler W, Soler-Soler J, Swedberg K (1997) A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: the Flolan International Randomized Survival Trial (FIRST). Am Heart J 134(1):44–54CrossRefPubMed

40.

Anand I, McMurray J, Cohn JN, Konstam MA, Notter T, Quitzau K, Ruschitzka F, Luscher TF (2004) Long-term effects of darusentan on left-ventricular remodelling and clinical outcomes in the Endothelin A Receptor Antagonist Trial in Heart Failure (EARTH): randomised, double-blind, placebo-controlled trial. Lancet 364(9431):347–354CrossRefPubMed

41.

Bonderman D, Ghio S, Felix SB, Ghofrani HA, Michelakis E, Mitrovic V, Oudiz RJ, Boateng F, Scalise AV, Roessig L, Semigran MJ (2013) Riociguat for patients with pulmonary hypertension caused by systolic left ventricular dysfunction: a phase IIb double-blind, randomized, placebo-controlled, dose-ranging hemodynamic study. Circulation 128(5):502–511CrossRefPubMed

42.

Cooper TJ, Guazzi M, Al-Mohammad A, Amir O, Bengal T, Cleland JG, Dickstein K (2013) Sildenafil in Heart failure (SilHF). An investigator-initiated multinational randomized controlled clinical trial: rationale and design. Eur J Heart Fail 15(1):119–122CrossRefPubMed

43.

Pieske B, Butler J, Filippatos G, Lam C, Maggioni AP, Ponikowski P, Shah S, Solomon S, Kraigher-Krainer E, Samano ET, Scalise AV, Muller K, Roessig L, Gheorghiade M (2014) Rationale and design of the SOluble guanylate Cyclase stimulatoR in heArT failurE studies (SOCRATES). Eur J Heart Fail 16(9):1026–1038CrossRefPubMed

44.

Guazzi M, Vicenzi M, Arena R, Guazzi MD (2011) Pulmonary hypertension in heart failure with preserved ejection fraction: a target of phosphodiesterase-5 inhibition in a 1-year study. Circulation 124(2):164–174CrossRefPubMed

45.

Bonderman D, Pretsch I, Steringer-Mascherbauer R, Jansa P, Rosenkranz S, Tufaro C, Bojic A, Lam CS, Frey R, Ochan Kilama M, Unger S, Roessig L, Lang IM (2014) Acute hemodynamic effects of riociguat in patients with pulmonary hypertension associated with diastolic heart failure (DILATE-1): a randomized, double-blind, placebo-controlled, single-dose study. Chest 146(5):1274–1285CrossRefPubMedPubMedCentral

46.

Sossalla S, Wagner S, Rasenack EC, Ruff H, Weber SL, Schondube FA, Tirilomis T, Tenderich G, Hasenfuss G, Belardinelli L, Maier LS (2008) Ranolazine improves diastolic dysfunction in isolated myocardium from failing human hearts—role of late sodium current and intracellular ion accumulation. J Mol Cell Cardiol 45(1):32–43CrossRefPubMed

47.

Khan SS, Cuttica MJ, Beussink-Nelson L, Kozyleva A, Sanchez C, Mkrdichian H, Selvaraj S, Dematte JE, Lee DC, Shah SJ (2015) Effects of ranolazine on exercise capacity, right ventricular indices, and hemodynamic characteristics in pulmonary arterial hypertension: a pilot study. Pulm Circ 5(3):547–556CrossRefPubMedPubMedCentral

48.

Bursi F, McNallan SM, Redfield MM, Nkomo VT, Lam CS, Weston SA, Jiang R, Roger VL (2012) Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol 59(3):222–231CrossRefPubMedPubMedCentral

49.

Agarwal R, Shah SJ, Foreman AJ, Glassner C, Bartolome SD, Safdar Z, Coslet SL, Anderson AS, Gomberg-Maitland M (2012) Risk assessment in pulmonary hypertension associated with heart failure and preserved ejection fraction. J Heart Lung Transplant 31(5):467–477CrossRefPubMed

50.

Benza RL, Raina A, Abraham WT, Adamson PB, Lindenfeld J, Miller AB, Bourge RC, Bauman J, Yadav J (2015) Pulmonary hypertension related to left heart disease: insight from a wireless implantable hemodynamic monitor. J Heart Lung Transplant 34(3):329–337CrossRefPubMed

51.

Al-Naamani N, Preston IR, Paulus JK, Hill NS, Roberts KE (2015) Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction. JACC Heart Fail 3(6):467–474CrossRefPubMedPubMedCentral

52.

Taylor BJ, Smetana MR, Frantz RP, Johnson BD (2015). Submaximal exercise pulmonary gas exchange in left heart disease patients with different forms of pulmonary hypertension. J Card Fail 21(8):647–655CrossRefPubMed

53.

Enson Y, Wood JA, Mantaras NB, Harvey RM (1977) The influence of heart rate on pulmonary arterial-left ventricular pressure relationships at end-diastole. Circulation 56(4 Pt 1):533–539CrossRefPubMed

54.

Sibbald WJ, Paterson NA, Holliday RL, Anderson RA, Lobb TR, Duff JH (1978) Pulmonary hypertension in sepsis: measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors. Chest 73(5):583–591CrossRefPubMed

55.

Redfield MM, Chen HH, Borlaug BA, Semigran MJ, Lee KL, Lewis G, LeWinter MM, Rouleau JL, Bull DA, Mann DL, Deswal A, Stevenson LW, Givertz MM, Ofili EO, O’Connor CM, Felker GM, Goldsmith SR, Bart BA, McNulty SE, Ibarra JC, Lin G, Oh JK, Patel MR, Kim RJ, Tracy RP, Velazquez EJ, Anstrom KJ, Hernandez AF, Mascette AM, Braunwald E (2013) Effect of phosphodiesterase-5 inhibition on exercise capacity and clinical status in heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 309(12):1268–1277CrossRefPubMed

56.

Hoendermis ES, Liu LC, Hummel YM, van der Meer P, de Boer RA, Berger RM, van Veldhuisen DJ, Voors AA (2015). Effects of sildenafil on invasive haemodynamics and exercise capacity in heart failure patients with preserved ejection fraction and pulmonary hypertension: a randomized controlled trial. Eur Heart J 36(38):2565–2573CrossRefPubMed

57.

Zile MR, Bourge RC, Redfield MM, Zhou D, Baicu CF, Little WC (2014) Randomized, double-blind, placebo-controlled study of sitaxsentan to improve impaired exercise tolerance in patients with heart failure and a preserved ejection fraction. JACC Heart Fail 2(2):123–130CrossRefPubMed

Titel: Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction
verfasst von: Debra D. Dixon
Amar Trivedi
Sanjiv J. Shah
Publikationsdatum: 29.12.2015
Verlag: Springer US
Erschienen in: Heart Failure Reviews / Ausgabe 3/2016
Print ISSN: 1382-4147
Elektronische ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-015-9523-6

Neu im Fachgebiet Kardiologie

25.04.2024 | Hypotonie | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Combined post- and pre-capillary pulmonary hypertension in heart failure with preserved ejection fraction

Abstract

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2016

Classification and diagnosis of pulmonary hypertension

Hospital and intensive care unit management of decompensated pulmonary hypertension and right ventricular failure

The right ventricle and pulmonary hypertension

Molecular pathogenesis and current pathology of pulmonary hypertension

Chronic thromboembolic pulmonary hypertension: detection, medical and surgical treatment approach, and current outcomes

Definition, epidemiology and registries of pulmonary hypertension

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie