UMEM Educational Pearls

Heart Failure & Pulmonary Hypertension (Part I)

~50% of patients with heart failure & preserved ejection fraction (HFpEF) develop pulmonary hypertension (PH)

HFpEF with PH portends reduced survival and increased hospitalization rates compared to those without PH

HFpEF-PH is often confused with idiopathic pulmonary hypertension (IPAH) given the similar hemodynamics; differentiating them is challenging and requires careful consideration of clinical, radiologic, and hemodynamic data

 

 

PAH

HFpEF

Clinical parameters:

 Age

Typically 3rd–5th decade

Typically 6th–8th decade

 Comorbidities (HTN, HLD, DM, CAD)

Rare

Common

 Atrial arrhythmias

Rare

Common

 Obstructive sleep apnea

Rare

Common

Echocardiographic parameters:

 LA size/volume

Normal

Increased

 LV diastolic function

Normal to mildly abnormal

Moderate to severely abnormal

Hemodynamic parameters:

 Resting PAWP

Always <15 mmHg

May be < or >15 mmHg

 Response to volume

PAWP <15 mmHg (increase ≤5 mmHg)

PAWP >15 mmHg (increase >5 mmHg)

 Response to exercise

PAWP <15 mmHg (increase ≤5 mmHg)

PAWP >15 mmHg (increase >5 mmHg)

(Table reproduced from article)

 

References

Kanwar M, Tedford R, et al. Management of Pulmonary Hypertension due to Heart Failure with Preserved Ejection Fraction. Current Hypertension Reports. October 16, 2014