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The following is a summary of “Clinical Implications of Pretest Probability of HFpEF on Outcomes in Precapillary Pulmonary Hypertension,” published in the November 2024 issue of Cardiology by Reddy et al.    

Patients with group 1 pulmonary hypertension (PH) and risk factors for heart failure with preserved ejection fraction (HFpEF) show poorer responses to pulmonary vasodilator therapy.  

Researchers conducted a prospective study to compare exercise capacity, cardiac function, and hemodynamic responses to provocative maneuvers based on pretest probability for HFpEF in group patients with 1 PH.  

They assessed the pretest probability for HFpEF using the HFpEF-ABA algorithm (based on age, body mass index [BMI], and atrial fibrillation [AF] history) among group patients with 1 PH enrolled in the multicenter PVDOMICS (Redefining PH through Pulmonary Vascular Disease Phenomics) study. Functional capacity, QoL, and pulmonary capillary wedge pressure (PCWP) responses were compared across low (<25%), intermediate (25%-74%), and high (≥75%) HFpEF probability groups.  

The results showed 424 patients with group 1 PH, 54% (n = 228) had intermediate HFpEF probability, and 15% (n = 64) had high HFpEF probability. Resting PCWP increased progressively with higher HFpEF probability (P<0.0001). Patients with high HFpEF probability exhibited the greatest PCWP increases with nitric oxide, fluid challenge, and exercise (P<0.001 for all). Responses were similar to those in patients with HFpEF without pulmonary vascular disease (n = 194) but lower than in those with combined precapillary and postcapillary PH. Patients with high HFpEF probability had the most abnormal left ventricular (LV)/atrial size, diastolic function, quality of life, 6-minute walk distance (6MWD), and peak VO₂ (P<0.0001 for all). Higher HFpEF probability in group 1 PH was linked to increased mortality risk (HR per decile of HFpEF probability 1.09; 95% CI: 1.05-1.13; P<0.0001).  

They concluded that quantifying the pretest probability for HFpEF in group 1 PH helped identify a subset with worse dynamic PCWP response and poorer outcomes, signaling the need for further research on therapies for this group.  

Source: jacc.org/doi/10.1016/j.jacc.2024.08.061