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Pulmonary hypertension due to left heart disease: Overview of characteristics and its impact on short and long-term prognosis
Authors: Aneida Hodo Vevecka, Marinela Serban, Jola Klosi, Elizana Petrela, Ergita Nelaj, Mihal Tase, Carmen Ginghina
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Aim: To assess the clinical, echocardiographic and laboratory characteristics of pulmonary hypertension (PH) due to left heart diseases (LHDs), and to assess the prognostic role of PH in patients with LHDs.
Methods: This study was conducted at the University Hospital Center Mother Teresa in Tirana and the Institute of Cardiovascular Emergencies Prof. C.C Iliescu , Bucharest. The study population included 208 patients, 53.8% female, average age 63.04±11.26 years. Inclusion criteria consisted of pulmonary artery systolic pressure (PASP) >50 mmHg due to LHDs. Patients were divided into four major groups: patients with left ventricle (LV) systolic dysfunction (N=71), patients with LV diastolic dysfunction (N=35), patients with mitral (N=66) and aortic (N=36) valvulopathies. Anthropometric data, symptoms, blood tests, transthoracic echocardiography, six-minute walking test distance (6MWT), comorbidities and treatment were recorded. Data regarding death were taken from family if death occurred outside hospital. Patients were followed every six months. Average follow-up time was 1.8±1.2 years.
Results: PASP correlated will the severity of heart failure (r=0.268, P<0.001) and 6MWT distances (r= - 0.313, P<0.001). There was no significant relationship between PASP and LV ejection fraction (r=0.107, P=0.126). PASP correlated with LV diastolic dysfunction (r=0.206, P=0.034). PASP directly influenced mortality (r=0.348, P<0.001): each unit increase of PASP, increased by 8.5% the probability of death.
Conclusion: PH due to LHDs aggravates HF symptoms and reduces physical activity, indifferent of LVEF. PASP is influenced by LV diastolic dysfunction. With its powerful impact on mortality, PH may be considered a marker of primary disease which requires specific treatment.