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Heart Failure & Pulmonary Hypertension (Part I)
~50% of patients with heart failure & preserved ejection fraction (HFpEF) develop pulmonary hypertension (PH)
HFpEF with PH portends reduced survival and increased hospitalization rates compared to those without PH
HFpEF-PH is often confused with idiopathic pulmonary hypertension (IPAH) given the similar hemodynamics; differentiating them is challenging and requires careful consideration of clinical, radiologic, and hemodynamic data
|
| PAH | HFpEF |
| Clinical parameters: | ||
| Age | Typically 3rd–5th decade | Typically 6th–8th decade |
| Comorbidities (HTN, HLD, DM, CAD) | Rare | Common |
| Atrial arrhythmias | Rare | Common |
| Obstructive sleep apnea | Rare | Common |
| Echocardiographic parameters: | ||
| LA size/volume | Normal | Increased |
| LV diastolic function | Normal to mildly abnormal | Moderate to severely abnormal |
| Hemodynamic parameters: | ||
| Resting PAWP | Always <15 mmHg | May be < or >15 mmHg |
| Response to volume | PAWP <15 mmHg (increase ≤5 mmHg) | PAWP >15 mmHg (increase >5 mmHg) |
| Response to exercise | PAWP <15 mmHg (increase ≤5 mmHg) | PAWP >15 mmHg (increase >5 mmHg) |
(Table reproduced from article)
References
Kanwar M, Tedford R, et al. Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction. Current Hypertension Reports. October 16, 2014