RESEARCH ARTICLE


Pulmonary Hypertension in Elderly Patients with Diastolic Dysfunction and Preserved Ejection Fraction



Majid Afshar1, Fareed Collado2, Rami Doukky3, *
1 Section of Pulmonary and Critical Care, University of Maryland, Baltimore, Maryland, USA
2 Department of Medicine, Rush University Medical Center, Chicago, IL, USA
3 Section of Cardiology, Rush University Medical Center, Chicago, IL, USA


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© Afshar et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to these authors at the Rush University Medical Center, Section of Cardiology, 1653 W. Congress Pkwy, Jelke Bldg, Suite # 1015, Chicago, IL 60612, USA; Tel: 708-288-6046; Fax: 312-942-6334; E-mail: rami_doukky@rush.edu


Abstract

Purpose:

Patients with diastolic dysfunction may have a disproportionate degree of elevation in pulmonary pressure, particularly in the elderly. Higher pulmonary vascular resistance in the elderly patients with heart failure but preserved ejection fraction suggests that beyond the post-capillary contribution of pulmonary venous congestion, a pre-capillary component of pulmonary arterial hypertension occurs. We aim to identify if pulmonary vascular resistance in elderly patients with diastolic dysfunction is disproportionately higher than patients with systolic dysfunction independent of filling pressures.

Methods:

389 patients identified retrospectively between 2003- 2010; elderly with preserved ejection fraction, elderly with depressed ejection fraction, and primary arterial hypertension who underwent right-heart catheterization at Rush University.

Results:

No significant difference in pulmonary vascular resistance between systolic and diastolic dysfunction. The mean difference in pulmonary vascular resistance was not statistically significant at 0.40 mmHg·min/l (95% CI -3.03 to 3.83) with similar left ventricular filling pressures with mean difference of 3.38 mmHg (95% CI, -1.27 to 8.02). When adjusted for filling pressures, there remained no difference in pulmonary vascular resistance for systolic and diastolic dysfunction. The mean pulmonary vascular resistance is more elevated in systolic heart failure compared to diastolic heart failure with means 3.13 mmHg·min/l and 3.52 mmHg·min/l, respectively.

Conclusion:

There was no other association identified for secondary pulmonary hypertension other than diastolic dysfunction and chronic venous pulmonary hypertension. Our results argue against any significant arterial remodeling that would lead to disproportionate pre-capillary hypertension, and implies that treatment should focus on lowering filling pressure rather than treating the pulmonary vascular tree.

Keywords: Diastolic heart failure, heart failure, preserved left ventricular ejection function, pulmonary hypertension, right heart catheterization..