The study on etiology and clinical characteristics of pulmonary hypertension due to left heart disease

DAI Xue; WANG Ke

doi:10.3969/j.issn.1672-5301.2018.02.018

Abstract：Objective To investigate the incidence and etiology composition of pulmonary hypertension due to left heart disease(PH-LHD),and analysis the clinical characteristics of PH-LHD patients.Methods Left heart failure patients were enrolled in this study,the etiology of left heart failure including:ischemic heart disease (IHD),dilated cardiomyopathy (DCM),hypertensive heart disease (HHD),hypertrophic cardiomyopathy (HCM) and valvular heart disease (VHD).The maximum velocity of tricuspid regurgitation (TRVmax) were measured by Doppler echocardiography,and PASP(pulmonary artery systolic pressure)was calculated[=4×TRVmax2+right artial pressure(RAP)].The history,clinical vital signs,treatment,complications and echocardiographic parameters were collected.Results (1)The incidence of pulmonary hypertension in the all enrolled left heart disease was 26.72％.(2)In PH-LHD patients,the etiology composition of left heart disease as follows:IHD 36.87％,VHD 29.95％,DCM 19.82％,HHD 6.91％ and HCM 6.45％.(3)Removing the VHD patients from left heart failure patients,429 of them were HFrEF,and The incidence of PH in patients with HFrEF was 29.37％;the incidence of PH in patients with HFpEF was 13.27％.The etiology composition of PH-LHD in patients with HFpEF:HCM 42.31％,HHD 34.62％ and IHD 23.07％.The etiology composition of PH-LHD in patients with HFrEF:IHD 58.73％,DCM 34.13％,HHD 4.76％ and HCM 2.38％.The etiology composition between two groups has significant difference (P=-0.000).(4)In PH-LHD patients,selected DCM and IHD patients (LVEF＜50％,DCM with PH was defined as group A,IHD with PH was defined as group B).Comparing with the group B,the patients in group A demonstrated a higher proportion of male and moderate-severe mitral regurgitation,the size of left atrial and left ventricular were increased,and lower left ventricular ejection fraction (P＜0.05).Comparing with the group A,Patients in group B were older,higher SBP,and higher prevalence of diabetes,chronic renal failure and hypertension (P＜0.05).Conclusion (1)IHD and VHD are the two major causes of PH-LHD patients.(2)The two major cause of PH-LHD in patients with HFpEF are HCM and HHD,while in patients with HFrEF are IHD and DCM.(3)Comparison the clinical characteristics between DCM and IHD patients with PH,the former has mostly male patients,left heart size increased significantly,LVEF significandy reduced.