• Massimiliano Palazzini, Fabio Dardi, Alessandra Manes, Bacchi Reggiani Maria L ML Department of Investigational, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy., Enrico Gotti, Andrea Rinaldi, Alessandra Albini, Enrico Monti, and Nazzareno Galiè.
• Department of Investigational, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
• Eur. J. Heart Fail. 2018 Feb 1; 20 (2): 248-255.

AimsPulmonary hypertension (PH) is a relevant complication of left heart disease (LHD). The 2015 ESC/ERS PH guidelines report two different haemodynamic subsets of PH due to LHD (PH-LHD) based on levels of pulmonary vascular resistance (PVR) and diastolic pressure gradient (DPG): isolated post-capillary PH (Ipc-PH) and combined post- and pre-capillary PH (Cpc-PH). The objective of this study is to evaluate the prognostic value of Ipc-PH and Cpc-PH.Methods And ResultsData from 276 consecutive incident patients with PH-LHD were included. According to the guidelines, Ipc-PH is defined by DPG <7 mmHg and/or PVR ≤3 Wood units (WU) and Cpc-PH by DPG ≥7 mmHg and/or PVR >3 WU. Using this definition, we identified three patient groups: Ipc-PH with both normal PVR and DPG (108 patients); Cpc-PH with both increased PVR and DPG (66 patients); and an intermediate group with either increased PVR or DPG (102 patients). Survival was estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Patients with Ipc-PH had better survival compared with the group of patients with Cpc-PH (P = 0.026) and the intermediate group (P = 0.025). No survival difference was detected between patients with Cpc-PH and the intermediate group (P = 0.891). Patients with normal PVR had a better survival compared with those with elevated PVR (P = 0.012); while no difference was observed according to the level of DPG (P = 0.253).ConclusionPatients with Ipc-PH have a better prognosis compared with patients with Cpc-PH and with patients with isolated increase of PVR or DPG. Pulmonary vascular resistance has a better predictive value than DPG in patients with PH-LHD.© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

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