Characteristics of pulmonary hypertension in adults with left ventricular diastolic dysfunction

Left ventricular diastolic dysfunction (LVDD) is commonly associated with pulmonary hypertension (PHT), however the factors associated with the presence and severity of PHT in patients with LVDD have not been well characterised.

We aimed to (1) identify the factors which are significantly associated with the presence of PHT in patients with LVDD and (2) determine which factors are significantly associated with the severity of PHT.

We analysed the profiles and echo characteristics of 16,058 adults with LVDD (as defined by current guidelines) and preserved LV ejection fraction (>50%) from the National Echocardiography Database of Australia. Peak tricuspid regurgitation velocity (TRV) was used to determine the presence of PHT. Univariate and multivariate analyses were performed to evaluate the parameters associated with the presence/increasing severity of PHT.

Mean age was 73±12years and 9216 (57.4%) were women. 2503 (15.6%) subjects had atrial fibrillation (AF) and 13,555 (84.4%) were in sinus rhythm. Overall, 9976 (62.1%) had PHT (TRV>2.9m/sec). There was a progressive increase in indexed LA volume with rising TRV levels (Figure 1). However, there was no clear association between worsening E/e’ and TRV, or, increasing age and TRV. AF and right ventricle (RV) dilation were strongly associated with the presence of PH (adjusted odds ratio, aOR 1.27; 95% confidence interval, CI, 1.12-1.43) and aOR 4.99 (95%CI 4.44-5.62) respectively. Increased age, LVEF and body mass index were also independently associated with PHT (p<0.001). These trends were maintained when on sensitivity analyses assessing the AF and sinus rhythm cohorts separately. On multivariate analysis, older age, female sex, AF, lower E/e’ and LVEF were independently associated with the severity of PHT(p<0.001). The presence of AF increased the TRV by an average of 0.32m/sec, RV dilation by 1.82m/sec, female sex by 0.32m/sec and age (per decade) by 0.3m/sec.

In this large study, PHT was common in LVDD and was strongly associated with the presence of enlarged LA, AF and older age, in particular (Figure 2).Figure 1:

Correlation between LAVi & TRV