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Pre-Capillary, Combined, and Post-Capillary Pulmonary Hypertension

Pulmonary hypertension (PH) is hemodynamically classified as pre-capillary (as seen in idiopathic pulmonary arterial hypertension [IPAH]) or post-capillary (as seen in heart failure with preserved ejection fraction [HFpEF]). Overlaps between these conditions exist. Some patients present with risk fa... Full description

Journal Title: Journal of the American College of Cardiology 26 July 2016, Vol.68(4), pp.368-378
Main Author: Opitz, Christian F
Other Authors: Hoeper, Marius M , Gibbs, J. Simon R , Kaemmerer, Harald , Pepke-Zaba, Joanna , Coghlan, J. Gerry , Scelsi, Laura , D’alto, Michele , Olsson, Karen M , Ulrich, Silvia , Scholtz, Werner , Schulz, Uwe , Grünig, Ekkehard , Vizza, Carmine D , Staehler, Gerd , Bruch, Leonhard , Huscher, Doerte , Pittrow, David , Rosenkranz, Stephan
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 0735-1097 ; E-ISSN: 1558-3597 ; DOI: 10.1016/j.jacc.2016.05.047
Link: https://www.sciencedirect.com/science/article/pii/S0735109716333149
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recordid: elsevier_sdoi_10_1016_j_jacc_2016_05_047
title: Pre-Capillary, Combined, and Post-Capillary Pulmonary Hypertension
format: Article
creator:
  • Opitz, Christian F
  • Hoeper, Marius M
  • Gibbs, J. Simon R
  • Kaemmerer, Harald
  • Pepke-Zaba, Joanna
  • Coghlan, J. Gerry
  • Scelsi, Laura
  • D’alto, Michele
  • Olsson, Karen M
  • Ulrich, Silvia
  • Scholtz, Werner
  • Schulz, Uwe
  • Grünig, Ekkehard
  • Vizza, Carmine D
  • Staehler, Gerd
  • Bruch, Leonhard
  • Huscher, Doerte
  • Pittrow, David
  • Rosenkranz, Stephan
subjects:
  • Heart Failure With Preserved Ejection Fraction
  • Idiopathic Pulmonary Arterial Hypertension
  • Medicine
ispartof: Journal of the American College of Cardiology, 26 July 2016, Vol.68(4), pp.368-378
description: Pulmonary hypertension (PH) is hemodynamically classified as pre-capillary (as seen in idiopathic pulmonary arterial hypertension [IPAH]) or post-capillary (as seen in heart failure with preserved ejection fraction [HFpEF]). Overlaps between these conditions exist. Some patients present with risk factors for left heart disease but pre-capillary PH, whereas patients with HFpEF may have combined pre- and post-capillary PH. This study sought to further characterize similarities and differences among patient populations with either PH-HFpEF or IPAH. We used registry data to analyze clinical characteristics, hemodynamics, and treatment responses in patients with typical IPAH (
language: eng
source:
identifier: ISSN: 0735-1097 ; E-ISSN: 1558-3597 ; DOI: 10.1016/j.jacc.2016.05.047
fulltext: fulltext
issn:
  • 0735-1097
  • 07351097
  • 1558-3597
  • 15583597
url: Link


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titlePre-Capillary, Combined, and Post-Capillary Pulmonary Hypertension
creatorOpitz, Christian F ; Hoeper, Marius M ; Gibbs, J. Simon R ; Kaemmerer, Harald ; Pepke-Zaba, Joanna ; Coghlan, J. Gerry ; Scelsi, Laura ; D’alto, Michele ; Olsson, Karen M ; Ulrich, Silvia ; Scholtz, Werner ; Schulz, Uwe ; Grünig, Ekkehard ; Vizza, Carmine D ; Staehler, Gerd ; Bruch, Leonhard ; Huscher, Doerte ; Pittrow, David ; Rosenkranz, Stephan
ispartofJournal of the American College of Cardiology, 26 July 2016, Vol.68(4), pp.368-378
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subjectHeart Failure With Preserved Ejection Fraction ; Idiopathic Pulmonary Arterial Hypertension ; Medicine
descriptionPulmonary hypertension (PH) is hemodynamically classified as pre-capillary (as seen in idiopathic pulmonary arterial hypertension [IPAH]) or post-capillary (as seen in heart failure with preserved ejection fraction [HFpEF]). Overlaps between these conditions exist. Some patients present with risk factors for left heart disease but pre-capillary PH, whereas patients with HFpEF may have combined pre- and post-capillary PH. This study sought to further characterize similarities and differences among patient populations with either PH-HFpEF or IPAH. We used registry data to analyze clinical characteristics, hemodynamics, and treatment responses in patients with typical IPAH (<3 risk factors for left heart disease; n = 421), atypical IPAH (≥3 risk factors for left heart disease; n = 139), and PH-HFpEF (n = 226) receiving PH-targeted therapy. Compared with typical IPAH, patients with atypical IPAH and PH-HFpEF were older, had a higher body mass index, had more comorbidities, and had a lower 6-min walking distance, whereas mean pulmonary artery pressure (46.9 ± 13.3 mm Hg vs. 43.9 ± 10.7 mm Hg vs. 45.7 ± 9.4 mm Hg, respectively) and cardiac index (2.3 ± 0.8 l/min/m vs. 2.2 ± 0.8 l/min/m vs. 2.2 ± 0.7 l/min/m , respectively) were comparable among groups. After initiation of targeted PH therapies, all groups showed improvement in exercise capacity, functional class, and natriuretic peptides from baseline to 12 months, but treatment effects were less pronounced in patients with PH-HFpEF than typical IPAH; with atypical IPAH in between. Survival rates at 1, 3, and 5 years were almost identical for the 3 groups. Patients with atypical IPAH share features of both typical IPAH and PH-HFpEF, suggesting that there may be a continuum between these conditions.
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