Heart failure with preserved ejection fraction and pulmonary hypertension: a survival analysis in a hispanic population

Abstract Background/Introduction Heart failure with preserved ejection fraction frequently coexists with pulmonary hypertension and significantly affects patient outcomes. Understanding the prevalence and clinical impact of this association is essential to improve current diagnostic and therapeutic strategies. Purpose To determine the prevalence, clinical characteristics, and survival of patients with preserved ejection fraction and pulmonary hypertension who were initially suspected of having pulmonary arterial hypertension. Methods We conducted a retrospective, observational study of 299 patients referred to a tertiary care centre with a diagnosis of pulmonary arterial hypertension. After excluding patients with left ventricular systolic dysfunction, significant valvulopathies, chronic lung disease, or chronic thromboembolic disease, we re-evaluated haemodynamic data from right heart catheterisation. Patients were classified as having precapillary or postcapillary pulmonary hypertension; those with postcapillary physiology were further stratified based on pulmonary vascular resistance and diastolic pressure gradient. We collected demographic, clinical, echocardiographic, and laboratory data, as well as survival information over the follow-up period. Results Of the 299 patients analysed, 41 (14%) were ultimately reclassified as having postcapillary pulmonary hypertension caused by heart failure with preserved ejection fraction. Compared with patients who met the criteria for true precapillary disease, those in the postcapillary group had higher pulmonary capillary wedge pressures (mean 18.7±4.6 mmHg) and more frequent comorbidities such as systemic hypertension and diabetes mellitus. Overall mortality for the entire cohort was 21%, with patients in the postcapillary group showing a higher risk of adverse outcomes when other prognostic factors (e.g. right atrial pressure, cardiac output) were taken into account. Conclusion This study highlights a subgroup of patients with misclassified pulmonary hypertension who in fact, had left-sided cardiac involvement, leading to postcapillary elevations in pulmonary pressure. These findings emphasize the critical importance of comprehensive hemodynamic assessment to accurately differentiate between precapillary and postcapillary pulmonary hypertension, as misclassification can result in suboptimal treatment strategies, worsening clinical outcomes, and reduced survival. Key hemodynamic parameters, such as pulmonary capillary wedge pressure and pulmonary vascular resistance, should be carefully evaluated to ensure precise diagnosis and appropriate management. A more refined hemodynamic characterization will enable tailored therapeutic approaches, prevent ineffective interventions, and ultimately improve outcomes in patients with heart failure and preserved ejection fraction complicated by pulmonary hypertension.Kaplan-Meier Survival Estimator Proportion of Survivors by Month