[Functional characterization of patients with isolated post-capillary or combined post-capillary and pre-capillary pulmonary hypertension].

Background: The World Conference on PH recommended differentiation of isolated postcapillary (Ipc) and combined post- and precapillary (Cpc) PH according to pulmonary vascular resistance alone. The aim of this study was the haemodynamic and functional characterization of patients diagnosed IpcPH and CpcPH according to the current recommendation of the latest World Symposium on Pulmonary Hypertension (PH) with an exploratory data analysis.
Methods: We evaluated all consecutive patients presenting at the PH outpatient clinic of Mission Medical Hospital from 2008-2015. All received a complete diagnostic work-up according to the guidelines. We analyzed data of patients with mPAP≥ 25 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. We compared anthropometric, hemodynamic and functional data of six-minute walking test (6 MWT), cardiopulmonary exercise testing (CPET) and echocardiography of patients with IpcPH and CpcPH.
Results: Out of 726 patients 58 showed a postcapillary PH: IpcPH: n = 20; CpcPH: n = 38. Patients with IpcPH had a significantly lower mPAP and PVR than patients with CpcPH. Cardiac index was lower in the Cpc-PH group compared to the IpcPH group. Functional capacity did not differ. CpcPH patients showed a higher right/left atrial area (RA/LA)-ratio.
Discussion and Conclusion: Although CpcPH patients showed higher values of mPAP and PVR functional capacity was not worse than in patients with IpcPH. In patients with PH due to left heart disease an elevated RA/LA ratio may indicate CpcPH and invasive diagnostic work-up should be considered.
Competing Interests: Matthias Held erklärt, dass er Beraterhonorare von Bayer Healthcare, Boehringer Ingelheim, Janssen, und MSD erhalten hat und Vortragshonorare von Astra Zeneca, Bayer HealthCare, Berlin Chemie, Boehringer Ingelheim, Bristol Myers Squibb, Daichi Sankyo, Janssen, MSD, Pfizer, Santis erhalten hat.Gülmisal Güder erklärt, dass sie Fördermittel des Bundesministeriums für Bildung und Forschung, der Deutschen Herzstiftung und der Deutschen Gesellschaft für Kardiologie erhalten und war beratend bzw. als Referentin für die Firmen AstraZeneca, Abiomed, Bayer, Boehringer Ingelheim, Novartis, Orion GmbH, Pfizer und Vifor Pharma Germany tätig. Mit der aktuellen Studie gibt es keine Interessenkonflikte.Franziska Joa erklärt, dass sie Vortragshonorare von Berlin- Chemie, Bayer, Boehringer Ingelheim, Actelion, Johnson and Johnson erhalten hat.Elena Pfeuffer-Jovic erklärt, Reisekostenunterstützung von Actelion, Boehringer Ingelheim, Novartis und OMT erhalten zu haben.Simon Weiner, Jörg Hoffmann und Johanna Walthelm-Hösel erklären keine Interessenkonflikte zu haben.
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