Pulmonary hypertension (PH) is a mean pulmonary arterial systolic pressure (mPASP) greater than 25mmHg at rest and 30mmHg during exercise. The prevalence of PH in heart failure with reduced ejection fraction (HFrEF) has previously been reported to vary, with a 10% prevalence of PH in heart failure reported in smaller studies. The aim of this study was to evaluate the prevalence of PH in HFrEF. We also evaluated the association between left ventricular ejection fraction (LVEF) with mPASP and left atrial (LA) size and contributing factors of PH in our patients.
A total of 173 patients (48% males, mean age 52 years) with HFrEF, LVEF <50% were studied. Two-dimensional transthoracic echocardiographic images were evaluated, prospectively and introspectively, between 1 January 2016 and 30 October 2018. Patients were divided into 2 groups, based on echocardiographic evidence of PH or not, further subdivided into tertiles based on the severity of LV systolic dysfunction, and later based on the severity of PH. This was an age and gender matched study.
The prevalence of PH and duration of heart failure symptoms were 72% and 8 weeks to 6 months, respectively. There was a strong inverse relationship between the severity of LVEF impairment and PH, as patients with severely impaired LV systolic function demonstrated more severe PH; Ɣ2 -0.82, p<0.0001. There was a strong relationship between the LVEF and LA size Ɣ2 -0.83, p=0.002 and between LA size and severity of PH; Ɣ2 0.75, p<0.001. The following factors were associated with the development of PH: mitral incompetence, severity of LV dysfunction, older age, hypertension and diabetic (p<0.0001).
The prevalence of PH in HFrEF was higher in our study compared with previously reports, where the severity of PH strongly correlated with the severity of LV dysfunction and LA size in our study.