Scientific article
Open access

Long-term outcome of patients with combined post- and pre-capillary pulmonary hypertension

Published inEuropean heart journal open, vol. 3, no. 4, oead069
First online date2023-07-03

Aims: Pulmonary hypertension (PH) is a complex clinical condition, and left heart disease is the leading cause. Little is known about the epidemiology and prognosis of combined post- and pre-capillary PH (CpcPH).

Methods and results: This retrospective analysis of the Swiss PH Registry included incident patients with CpcPH registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient baseline characteristics [age, sex, mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure (PAWP), pulmonary vascular resistance (PVR), and risk factors, including World Health Organization (WHO)-functional class (FC), 6 min walk distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP), treatment, days of follow-up, and events (death or loss to follow-up) at last visit] were analysed by Kaplan-Meier and Cox regression analyses. Two hundred and thirty-one patients (59.3% women, age 65 ± 12 years, mPAP 48 ± 11 mmHg, PAWP 21 ± 5 mmHg, PVR 7.2 ± 4.8 WU) were included. Survival analyses showed a significantly longer survival for women [hazard ratio (HR) 0.58 (0.38-0.89); P = 0.01] and a higher mortality risk for mPAP > 46 mmHg [HR 1.58 (1.03-2.43); P = 0.04] but no association with age or PVR. Patients stratified to high risk according to four-strata risk assessment had an increased mortality risk compared with patients stratified to low-intermediate risk [HR 2.44 (1.23-4.84); P = 0.01]. A total of 46.8% of CpcPH patients received PH-targeted pharmacotherapy; however, PH-targeted medication was not associated with longer survival.

Conclusion: Among patients with CpcPH, women and patients with an mPAP ≤46 mmHg survived longer. Furthermore, risk stratification by using non-invasively assessed risk factors, such as WHO-FC, 6MWD, and NT-proBNP, as proposed for pulmonary arterial hypertension, stratified survival in CpcPH, and might be helpful in the management of these patients.

  • Combined post- and pre-capillary pulmonary hypertension
  • CpcPH
  • Left heart disease
  • PH-LHD
  • Pulmonary hypertension
  • Survival
Citation (ISO format)
TITZ, Anna et al. Long-term outcome of patients with combined post- and pre-capillary pulmonary hypertension. In: European heart journal open, 2023, vol. 3, n° 4, p. oead069. doi: 10.1093/ehjopen/oead069
Main files (1)
Article (Published version)
Secondary files (5)
ISSN of the journal2752-4191

Technical informations

Creation10/20/2023 2:11:00 PM
First validation11/15/2023 8:12:12 AM
Update time11/15/2023 8:12:12 AM
Status update11/15/2023 8:12:12 AM
Last indexation05/06/2024 5:21:21 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack