The following is a summary of “Left Ventricular Filling Pressure in Chronic Thromboembolic Pulmonary Hypertension,” published in the February 2023 issue of Cardiology by Gerges, et al.

Organized thrombi in the major pulmonary arteries block the blood flow in chronic thromboembolic pulmonary hypertension (CTEPH). Patients with CTEPH frequently have ischemic heart disease, metabolic syndrome, and left-sided valvular heart disease, which are clinical risk factors for pulmonary hypertension caused by left heart disease. For a study, researchers sought to determine the prevalence and prognostic consequences of increased left ventricular filling pressures (LVFP) in CTEPH.

In total, 593 CTEPH patients who underwent a first diagnostic right and left heart catheterization in a row were studied. The left ventricular end-diastolic pressure (LVEDP) and mean pulmonary arterial wedge pressure (mPAWP) were used to evaluate the LVFP. To determine which patients had elevated LVFP, two cutoffs were used: for the primary analysis, mPAWP and/or LVEDP >15 mm Hg, as advised by the most recent guidelines for pulmonary hypertension; and for the secondary analysis, mPAWP and/or LVEDP >11 mm Hg, which represented the upper limit of normal. Long-term mortality was evaluated along with clinical and echocardiographic characteristics.

In 63 (10.6%) and 222 (37.3%) individuals, the LVFP was more than 15 mm Hg. Age, systemic hypertension, diabetes, atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume were all identified by univariable logistic regression analysis as significant predictors of higher LVFP. In an adjusted analysis, atrial fibrillation, calcific aortic valve stenosis, mitral regurgitation, and left atrial volume remained independent LVFP determinants. Patients who had recently had pulmonary endarterectomy had greater LVFPs at follow-up (P = 0.002). Poorer long-term survival was linked to LVFP >15 mm Hg (P = 0.021) and >11 mm Hg (P = 0.006).

Increased LVFP was frequently seen, likely resulting from concomitant left heart disease, and indicated a poor prognosis in CTEPH.

Reference: jacc.org/doi/10.1016/j.jacc.2022.11.049