Aim: Pulmonary hypertension (PH) in patients with chronic left heart failure (LHF) represents an advanced stage of the disease. Yet,
our capability to predict the outcome of these patients remains limited. The aim of the present study was to investigate the outcome predictive potential of the systolic and diastolic right ventricular (RV) myocardial perfusion pressure.
Methods and Results: Of 393 patients with chronic LHF who underwent right heart catheterization, 264 presented with PH. Myocardial perfusion pressure was defined as the gradient between the aortic pressure and the RV intra-cavitary pressure, in systole (SPP), and diastole (DPP) respectively. During the follow-up (median 30.6 months), 41.7% of patients with PH died, as compared with only 18.4% in the LHF and no-PH group. The SPP was 87.3±32 mmHg in the PH group as compared to 107.1±24.8 in the no-PH group (p=0001). The DPP was similar in both groups, 62.9±17.2 vs 62.9±12.9 mmHg, respectively (p=0.97). No difference in the mortality event rate according to SPP quartiles was observed (p=0.33). In contrary, in DPP quartile analysis, the death rate in the two lower quartiles was significantly increased, 37.4% and 28.6%, as compared with 16.5% and 17.6% in the higher quartiles (p=0.002). In a multivariate analysis, the adjusted hazard ratio (HR) for all-cause mortality was 3.27 (95% Confidence Interval (CI) 1.31-8.18, p=0.01), 2.76 (95% CI 1.10-6.86, p=0.029) and 0.20 (95% CI 0.31-2.09, p=0.32) for the first, second and third DPP quartile, respectively, as compared with the highest quartile.
Conclusion: The results of our study suggest that the diastolic, and not systolic, RV myocardial perfusion pressure is a strong predictor for all-cause mortality in patients with chronic LHF and PH.
