Precapillary PAH patients with high HFpEF probability had a mixed phenotype and mortality rate between postcapillary PH and low-HF probability PAH patients.
Does stratification by the H₂PEEF score identify distinct hemodynamic profiles and prognosis in patients with precapillary pulmonary arterial hypertension compared to isolated PAH and postcapillary PH?
Patients with precapillary PAH and a high probability of HFpEF (H-PAH) exhibit a mixed hemodynamic phenotype and an intermediate mortality risk between postcapillary PH and isolated precapillary PAH.
Absolute Event Rate: 0% vs 0%
Abstract Background Many patients with precapillary pulmonary arterial hypertension (PAH) exhibit clinical features suggestive of postcapillary involvement, which can be identified using the H₂PEEF score. These patients often have multiple comorbidities and demonstrate a reduced response to vasodilator therapy. Purpose This study aims to compare patients with isolated precapillary PAH and those at high risk of postcapillary involvement against true postcapillary pulmonary hypertension (PH) in terms of hemodynamic profile and prognosis. Patient stratification was based on the H₂PEEF score, which is less influenced by confounding factors associated with PAH than the HFA-PEF score. Methods A total of 179 patients referred for pulmonary hypertension evaluation underwent right heart catheterization. Based on pulmonary artery wedge pressure (PAWP), they were classified as having either precapillary PAH (PH team) or postcapillary PH (PostPH). Among those with precapillary PAH, further stratification was performed using the H₂PEEF score to categorize them into low-probability (L-PAH) or high-probability (H-PAH) of heart failure with preserved ejection fraction (HFpEF). Hemodynamic and prognostic comparisons between groups were conducted using ANOVA. Results Of the 179 patients, 84 were classified as L-PAH, 27 as H-PAH, and 68 as post-PH. The mean PAWP values were 8 ± 4 mmHg in L-PAH, 11 ± 3 mmHg in H-PAH, and 23 ± 5 mmHg in post-PH. L-PAH patients were younger (p = 0.001), had fewer cardiovascular risk factors (p = 0.0001), and showed no atrial fibrillation (p = 0.00001) compared to the other groups. Despite similar NYHA functional class (p = 0.54) and NT-proBNP levels (p = 0.20), L-PAH patients had a significantly greater six-minute walk distance (6MWD) than the other groups (p = 0.002). Interestingly, despite having a normal PAWP, H-PAH patients exhibited a mixed phenotype, sharing characteristics with both L-PAH and post-PH patients. Their mortality rate was higher than post-PH patients but lower than L-PAH patients (Figure). Conclusion Patients with precapillary PAH who have a high probability of HFpEF exhibit echocardiographic features similar to those with postcapillary PH but have a worse prognosis close to those with isolated PAH.
Bauer et al. (Sat,) reported a other. Precapillary PAH patients with high HFpEF probability had a mixed phenotype and mortality rate between postcapillary PH and low-HF probability PAH patients.