PMID- 31174892 OWN - NLM STAT- MEDLINE DCOM- 20200330 LR - 20200330 IS - 1527-3288 (Electronic) IS - 0147-9563 (Linking) VI - 48 IP - 6 DP - 2019 Nov-Dec TI - The impact of left ventricular ejection fraction on heart failure patients with pulmonary hypertension. PG - 502-506 LID - S0147-9563(18)30632-0 [pii] LID - 10.1016/j.hrtlng.2019.05.006 [doi] AB - BACKGROUND: The most common cause of pulmonary hypertension (PH) in developed countries is left heart disease (LHD, group 2 PH). The development of PH in heart failure (HF) patients is indicative of worse outcomes. OBJECTIVE: The aim of this study was to evaluate the long term outcomes of HF patients with PH in a national long-term registry. METHODS: Study included 9 cardiology centers across Israel between 01/2013-01/2015, with a 12-month clinical follow-up and 24-month mortality follow-up. Patients were age >/=18 years old with HF and pre-inclusion PH due to left heart disease determined by echocardiography [estimated systolic pulmonary arterial pressure (SPAP) >/= 50 mmHg]. Patients were categorized into 3 groups: HF with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF >/= 50%) ejection fraction. RESULTS: The registry included 372 patients, with high prevalence of cardiovascular risk factors. Median HF duration was 4 years and 65% were in severe HF New York Heart Association (NYHA) classification >/=3. Mean systolic pulmonary artery pressure (SPAP) was 62 +/- 11 mmHg. During 2-years of follow-up, 54 patients (15%) died. Univariable predictors of mortality included NYHA grade 3-4, chronic renal failure, and SPAP >/= 65 mmHg. Severe PH was associated with mortality in HFpEF, but not HFmrEF or HFrEF, and remained significant after multivariable adjustment with an adjusted hazard ratio of 2.99, (95%CI 1.29-6.91, p = 0.010). CONCLUSIONS: The combination of HFpEF with severe PH was independently associated with increased mortality. Currently, HFpEF patients are included with group 2 PH patients. Defining HFpEF with severe PH as a sub-class may be more appropriate, as these patients are at increased risk and deserve special consideration. CI - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Zafrir, Barak AU - Zafrir B AD - Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel. FAU - Carasso, Shemy AU - Carasso S AD - Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; The Azriely Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. FAU - Goland, Sorel AU - Goland S AD - Heart Institute, Kaplan Medical Center, affiliated to the Hebrew University, Jerusalem, Rehovot 76100, Israel. FAU - Zilberman, Liaz AU - Zilberman L AD - Heart Institute, Kaplan Medical Center, affiliated to the Hebrew University, Jerusalem, Rehovot 76100, Israel. FAU - Klempfner, Robert AU - Klempfner R AD - The Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Israeli Center for Cardiovascular Research, Tel-Aviv, Israel. FAU - Shlomo, Nir AU - Shlomo N AD - The Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Israeli Center for Cardiovascular Research, Tel-Aviv, Israel. FAU - Radzishevsky, Evgeny AU - Radzishevsky E AD - Cardiology Department, Bnai Zion Medical Center, Haifa, Israel. FAU - Hasin, Tal AU - Hasin T AD - Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel. FAU - Shotan, Avraham AU - Shotan A AD - Hillel Yaffe MC, Hadera & Rapaport School of Medicine, Technion, Haifa, Israel. FAU - Vazan, Alicia AU - Vazan A AD - Hillel Yaffe MC, Hadera & Rapaport School of Medicine, Technion, Haifa, Israel. FAU - Weinstein, Jean Marc AU - Weinstein JM AD - Cardiology Division, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. FAU - Kinany, Wadi AU - Kinany W AD - Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; The Azriely Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. FAU - Dragu, Robert AU - Dragu R AD - Western Galilee Medical Center, Nahariya & The Azriely Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. FAU - Maor, Elad AU - Maor E AD - The Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. FAU - Grosman-Rimon, Liza AU - Grosman-Rimon L AD - Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; The Azriely Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. FAU - Amir, Offer AU - Amir O AD - Cardiovascular Institute, B Padeh Medical Center, Poriya, Israel; The Azriely Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel. Electronic address: OAmir@poria.health.gov.il. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20190605 PL - United States TA - Heart Lung JT - Heart & lung : the journal of critical care JID - 0330057 SB - IM MH - Aged MH - Aged, 80 and over MH - Blood Pressure MH - Echocardiography MH - Female MH - Heart Failure/*physiopathology MH - Humans MH - Hypertension, Pulmonary/*physiopathology MH - Israel MH - Male MH - Middle Aged MH - Prevalence MH - Prognosis MH - Prospective Studies MH - Registries MH - Stroke Volume/*physiology MH - Ventricular Function, Left/*physiology OTO - NOTNLM OT - Heart failure OT - Mortality OT - Pulmonary hypertension EDAT- 2019/06/09 06:00 MHDA- 2020/03/31 06:00 CRDT- 2019/06/09 06:00 PHST- 2018/12/22 00:00 [received] PHST- 2019/05/02 00:00 [revised] PHST- 2019/05/05 00:00 [accepted] PHST- 2019/06/09 06:00 [pubmed] PHST- 2020/03/31 06:00 [medline] PHST- 2019/06/09 06:00 [entrez] AID - S0147-9563(18)30632-0 [pii] AID - 10.1016/j.hrtlng.2019.05.006 [doi] PST - ppublish SO - Heart Lung. 2019 Nov-Dec;48(6):502-506. doi: 10.1016/j.hrtlng.2019.05.006. Epub 2019 Jun 5.