Auteurs
Zeitouni M, Morlon Q, Silvain J, Procopi N, Guedeney P, Rouanet S, Kerneis M, Hatem S, Hammoudi N, Le Feuvre C, Helft G, Collet JP, Lebreton G, Varnous S, Leprince P, Montalescot G; ACTION group.
Abstract
Background
The 2018 World Symposium on Pulmonary Hypertension (WSPH) changed the definition of pulmonary hypertension (PH) with a new threshold of mean pulmonary artery pressure (mPAP) above 20 mmHg.
Aims
To evaluate the profile and prognosis of patients with chronic heart failure (HF) considered for heart transplantation with the new definition of PH.
Methods
Patients with chronic HF considered for heart transplantation were classified as mPAP≤20mmHg, mPAP20-25mmHg, and mPAP≥25mmHg. Using a multivariate Cox model, we compared the mortality of patients with mPAP20-25mmHg, and mPAP≥25mmHg versus those with mPAP≤20mmHg.
Results
Of 693 patients with chronic HF considered for heart transplantation, 12.7%, 77.5% and 9.8% were classified as mPAP20-25mmHg, mPAP≥25mmHg and mPAP≤20mmHg. Patients of mPAP≥25mmHg and mPAP20-25mmHg categories were older than mPAP≤20mmHg (56 versus 55 and 52 year-old, p = 0.02) with more frequent co-morbidities. Within 2.8 years, the mPAP20-25mmHg category displayed a higher risk of mortality compared with those of the mPAP≤20mmHg category (aHR 2.75, 95% CI 1.27-5.97, p = 0.01). Overall, the new PH definition using a threshold of mPAP>20mmHg was associated with a higher risk of death (adj HR 2.71, 95% CI 1.26-5.80) than the previous definition (mPAP>25mmHg, aHR: 1.35 95% CI 1.00-1.83, p = 0.05).
Conclusions
One out of 8 patients with severe HF are reclassified as having PH following the 2018 WSPH. Patients with mPAP20-25mmHg evaluated for heart transplantation displayed significant co-morbidities and high mortality rates.
