American researchers have identified three blood-flow measurements that could help doctors predict the outcomes of people whose pulmonary hypertension stems from a serious heart condition.
The discovery applies to PH patients whose lung blood pressure disorder is associated with heart failure with preserved ejection fraction, or PH-HFpEF.
A diagnosis of heart failure typically means that a person’s heart has little or no ability to pump blood. In cases of HFpEF, which is also called diastolic heart failure, the heart’s left ventricle is defective, but it is still able to pump blood at a rate more than 50 percent of normal.
A research team decided to look for blood-flow measurements that could predict the outcomes of this patient population.
Their study, “Association Between Hemodynamic Markers of Pulmonary Hypertension and Outcomes in Heart Failure With Preserved Ejection Fraction,” appeared in the journal JAMA Cardiology.
Experts say patients with HFpEF are at high risk of developing pulmonary hypertension. In the study, 56 percent of patients with pulmonary hypertension-left heart disease had PH-HFpEF.
The research covered 10 ,023 pulmonary hypertension patients whose average age was 65. More than a fifth — 2,587 — had PH-HFpEF. They were diagnosed with pulmonary hypertension between January 2005 and September 2012.
Twenty-four percent of the patients died within a year of diagnosis, and 48 percent within five years. Twenty-eight percent were hospitalized for heart problems at one year and 47 percent at five years.
Researchers identified three blood-flow measurements that could predict a patient’s death or hospitalization for heart disease. One was transpulmonary gradient, or the difference between mean pulmonary arterial pressure and left atrial pressure. Another was pulmonary vascular resistance, which reflects changes in arteries that supply blood to the lungs. Still another was diastolic pressure gradient, or the difference between pulmonary artery diastolic pressure and mean pulmonary capillary wedge pressure.
These are all invasive tests using catheters to measure blood pressure in the arteries and heart.
The researchers pointed out that “PH can only be diagnosed invasively and therefore must be included in trials targeting this disease. Further, our data on poor outcomes in these patients provide evidence for a reasonable risk-benefit profile for such an approach.”
They said the measurements could also be used to assess the effectiveness of potential treatments for PH-HFpEF in clinical trials.
“In a large cohort referred for invasive hemodynamic assessment, PH-HFpEF was common. Transpulmonary gradient, pulmonary vascular resistance, and diastolic pulmonary gradient are all associated with mortality and cardiac hospitalizations,” the team said. “These findings may be useful for future clinical trial design.”
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