Gender has impact on survival in post-capillary pulmonary hypertension due to heart failure: insights from the prospective and multicentre PH-HF study
C Fauvel, J C Eicher, F Bauer, P De Groote, E Berthelot, J N Trochu, D Logeart, F Picard, S Renard, H Bouvaist, F Roubille, O Sitbon, T Damy, N LamblinAbstract
Background
Compared to patients with pre-capillary pulmonary hypertension, especially pulmonary arterial hypertension, gender-related differences in patients with post-capillary PH (pcPH) due to heart failure (HF) has received poor attention so far.
AIMS
To assess the disparities between male and female patients in patients with pcPH due to HF.
Methods
All patients with the need for right heart catheterization for their usual care and with pcPH (mean pulmonary artery pressure ≥ 20 mmHg, pulmonary artery wedge pressure > 15 mmHg) from the French prospective and multicentric PH-HF cohort were included in this analysis. Isolated pcPH (IpcPH) was defined as pcPH plus pulmonary vascular resistance (PVR) <2 WU or combined pcPH (CpcPH) otherwise. Patients where classified as HF with preserved ejection fraction (HFpEF) when left ventricular ejection fraction (LVEF) ≥50% and HFrEF otherwise. The primary composite endpoint was 3-years all-cause death.
Results
Overall, n=606 patients were inculded: 252 (42%) female and 354 (58%) male. pcPH was more likely secondary to HFpEF in female (69%) and secondary to HFrEF (73%) in male (p<0.001). Therefore, female patients depicted higher LVEF (p<0.001) and lower LV end-diastolic diameter (p<0.001). Female had lower left atrium volume index, lower RV end-diastolic area, better RV to pulmonary artery (PA) coupling (assessed by TAPSE/sPAP ratio p<0.001). Regarding haemodynamic, female patients had comparable mPAP (p=0.12), right atrial pressure (p=0.4), PA pulsatility index (p=0.8), PA compliance and elastance (p=0.7 and 0.8), but higher PVR (3.04 vs 2.74 WU, p=0.028), lower PAWP (p<0.001), higher cardiac index and stroke volume index (p<0.001 and 0.002) and tended to have higher RV stroke work index (p=0.067) compared to male. Despite higher PVR, female patients had better survival compared to male, especially male with CpcpH (log-rank p=0.0037, Figure1). Haemodynamic determinant of survival were different between male and female after multivariable Cox regression analyses (Figure2).
Conclusion
Compared to male, despite higher RV afterload, female patients with pcPH depicted better RV function, translating into better survival. It suggests better RV adaptation to afterlaod increase and that gender may play a major role in pcPH pathophysiology.3-years all-cause deathFor image description, please refer to the figure legend and surrounding text.Multivariable analysesFor image description, please refer to the figure legend and surrounding text.