1. Hemodynamic Effects of Pulmonary Arterial Hypertension-Specific Therapy in Patients With Heart Failure With Preserved Ejection Fraction and With Combined Post- and Precapillay Pulmonary Hypertension.
- Author
-
Huis In't Veld AE, Oosterveer FPT, De Man FS, Marcus JT, Nossent EJ, Boonstra A, Van Rossum ACB, Vonk Noordegraaf A, Bogaard HJ, and Handoko ML
- Subjects
- Adrenergic beta-Antagonists administration & dosage, Aged, Aged, 80 and over, Capillaries physiopathology, Cohort Studies, Diuretics administration & dosage, Drug Therapy, Combination, Female, Heart Failure physiopathology, Hemodynamics drug effects, Humans, Hypertension, Pulmonary physiopathology, Magnetic Resonance Imaging, Cine methods, Male, Middle Aged, Prospective Studies, Stroke Volume drug effects, Treatment Outcome, Heart Failure diagnostic imaging, Heart Failure drug therapy, Hemodynamics physiology, Hypertension, Pulmonary diagnostic imaging, Hypertension, Pulmonary drug therapy, Stroke Volume physiology
- Abstract
Background: Drugs approved for pulmonary arterial hypertension have been considered for patients with heart failure with preserved ejection fraction and combined post- and precapillary pulmonary hypertension (Cpc-PH). We aimed to study changes in cardiac volumes, cardiac load and left ventricular (LV) filling pressures in patients with heart failure with preserved ejection fraction and Cpc-PH in response to pulmonary arterial hypertension-specific treatment., Methods and Results: In this prospective study, 23 patients with heart failure with preserved ejection fraction and Cpc-PH underwent right-heart catheterization, including acute provocation testing (fluid loading and inhaled nitric oxide) and cardiac MRI at baseline. Right-heart catheterization and cardiac MRI were repeated after 4 months of treatment. At baseline, acutely increasing preload by fluid loading resulted in a significant increase in pulmonary arterial wedge pressure (PAWP), whereas reducing right ventricular (RV) afterload and increasing LV distensability by acute administration of inhaled nitric oxide had no effect on PAWP. After 4 months of treatment, we observed a significant reduction in RV and LV afterload and increased RV and LV stroke volume, but PAWP significantly increased., Conclusions: In patients with heart failure with preserved ejection fraction and Cpc-PH, 4 months of pulmonary arterial hypertension-specific treatment increased RV and LV stroke volume at the expense of increased PAWP. This increase in PAWP was similarly observed acutely after fluid loading., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF