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P168 Reduced Gas Transfer (tlco) Predicts Poor Outcome In Patients With Pulmonary Hypertension And Heart Failure With Preserved Ejection Fraction
  1. N Hussain,
  2. S Ramjug,
  3. C Billings,
  4. J Hurdman,
  5. CA Elliot,
  6. R Condliffe,
  7. DG Kiely
  1. Sheffield Pulmonary Vascular Disease Unit, Sheffield, UK

Abstract

Rationale There is limited data on predictors of survival in patients with Pulmonary Hypertension (PH) in the context of Heart Failure and Preserved Ejection Fraction (HF-pEF). Simple non-invasive tests to aid the physician in prognostication would be valuable. The aim of this study was to examine demographic and non-invasive predictors of outcome in PH-HF-pEF in a large well phenotyped PH registry.

Method In the ASPIRE Registry (Hurdman J et al Eur Resp J, 2012), 1737 consecutive, incident, treatment-naıve patients with suspected PH underwent diagnostic evaluation between February 2001 and 2010. Patients were diagnosed as PH-HF-pEF if no other causes of PH could be identified and they fulfilled the following criteria: signs and symptoms of heart failure; mean pulmonary artery pressure ≥25 mmHg at rest and pulmonary arterial wedge pressure >15 mmHg by RHC; preserved left ventricular systolic function (ejection fraction ≥50%) by echocardiography or CMR. Predictors of survival were assessed using forward stepwise Cox regression analysis. Variables with a p-value

Results 98 patients who fulfilled the diagnostic criteria for PH-HF-pEF were identified. Maximum duration of follow-up was 10 years with a mean follow up 4.9 ± 2.3 years, during which 33 (34%) patients died. After multivariate analysis, only ISWT distance HR 0.99 CI (0.99–1.00) and TLCO HR 0.96 CI(0.94–0.98) at baseline, were predictors of outcome (p < 0.01). Median predicted TLCO in the PH-HF-pEF population was 65%. The 5-year survival in those with a TLCO <65% predicted was 60%, compared with 85% in those whose TLCO was ≥65% (p < 0.01).

Conclusions Simple non-invasive testing such as TLCO and exercise capacity measured by the ISWT predict outcome in patients with PH-HF-pEF.

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