[Functional characterization of patients with isolated post-capillary or combined post-capillary and pre-capillary pulmonary hypertension]. / Funktionelle Charakterisierung von Patienten mit isoliert postkapillärer oder kombiniert post- und präkapillärer pulmonaler Hypertonie.

BACKGROUND: The World Conference on PH recommended differentiation of isolated postcapillary (Ipc) and combined post- and precapillary (Cpc) PH according to pulmonary vascular resistance alone. The aim of this study was the haemodynamic and functional characterization of patients diagnosed IpcPH and CpcPH according to the current recommendation of the latest World Symposium on Pulmonary Hypertension (PH) with an exploratory data analysis. METHODS: We evaluated all consecutive patients presenting at the PH outpatient clinic of Mission Medical Hospital from 2008-2015. All received a complete diagnostic work-up according to the guidelines. We analyzed data of patients with mPAP ≥ 25 mmHg and pulmonary capillary wedge pressure (PCWP  > 15 mmHg. We compared anthropometric, hemodynamic and functional data of six-minute walking test (6 MWT), cardiopulmonary exercise testing (CPET) and echocardiography of patients with IpcPH and CpcPH. RESULTS: Out of 726 patients 58 showed a postcapillary PH: IpcPH: n = 20; CpcPH: n = 38. Patients with IpcPH had a significantly lower mPAP and PVR than patients with CpcPH. Cardiac index was lower in the Cpc-PH group compared to the IpcPH group. Functional capacity did not differ. CpcPH patients showed a higher right/left atrial area (RA/LA)-ratio. DISCUSSION AND CONCLUSION: Although CpcPH patients showed higher values of mPAP and PVR functional capacity was not worse than in patients with IpcPH. In patients with PH due to left heart disease an elevated RA/LA ratio may indicate CpcPH and invasive diagnostic work-up should be considered.

Anxiety, Depression and Quality of Life in Pulmonary Hypertension: A Comparison of Incident and Prevalent Cases.

INTRODUCTION: Anxiety and depression are common in pulmonary hypertension (PH) and health-related quality of life (HRQoL) is reduced. Sufficient analyses in incident and prevalent patients are lacking, so we provide a comparative analysis of these groups with focus on anxiety, depression and HRQoL. METHODS: Depression, anxiety and HRQoL were retrospectively analyzed by Hospital Anxiety and Depression Scale (HADS) and Short Form 36 questionnaire in 91 prevalent and 21 incident PH outpatients from a German tertiary care center specialized in PH. The acquired data as well as hemodynamic and functional parameters of prevalent and incident cases were compared. RESULTS: HRQoL was reduced in both cohorts of patients. Incident patients had significantly worse HRQoL in physical dominated scales than prevalent patients (physical component summary score: p = 0.02; physical role performance: p < 0.01). Depression and anxiety were more pronounced in prevalent patients (elevated depression scales: 28.6% of incident group, 35.2% of prevalent group, elevated anxiety scores: 28.6% of incident group, 39.6% of prevalent group). The groups did not differ in hemodynamic data, but incident patients had significantly lower cardiac biomarkers such as NT-proBNP (p = 0.016) and hs-troponin (p = 0.017). The time since diagnosis was a predictor of the subscale physical role performance (p < 0.001). CONCLUSION: Physical domains of HRQoL seem to be more limited in incident patients with PH. Anxiety and depression are frequent in both groups. A screening for anxiety and depression is important from the onset of the diagnosis, and patients should receive appropriate therapy to improve HRQoL, anxiety and depression.

[Functional characterization of patients with isolated post-capillary or combined post-capillary and pre-capillary pulmonary hypertension]. / Funktionelle Charakterisierung von Patienten mit isoliert postkapillärer oder kombiniert post- und präkapillärer pulmonaler Hypertonie.

BACKGROUND: The World Conference on PH recommended differentiation of isolated postcapillary (Ipc) and combined post- and precapillary (Cpc) PH according to pulmonary vascular resistance alone. The aim of this study was the haemodynamic and functional characterization of patients diagnosed IpcPH and CpcPH according to the current recommendation of the latest World Symposium on Pulmonary Hypertension (PH) with an exploratory data analysis. METHODS: We evaluated all consecutive patients presenting at the PH outpatient clinic of Mission Medical Hospital from 2008-2015. All received a complete diagnostic work-up according to the guidelines. We analyzed data of patients with mPAP≥ 25 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. We compared anthropometric, hemodynamic and functional data of six-minute walking test (6 MWT), cardiopulmonary exercise testing (CPET) and echocardiography of patients with IpcPH and CpcPH. RESULTS: Out of 726 patients 58 showed a postcapillary PH: IpcPH: n = 20; CpcPH: n = 38. Patients with IpcPH had a significantly lower mPAP and PVR than patients with CpcPH. Cardiac index was lower in the Cpc-PH group compared to the IpcPH group. Functional capacity did not differ. CpcPH patients showed a higher right/left atrial area (RA/LA)-ratio. DISCUSSION AND CONCLUSION: Although CpcPH patients showed higher values of mPAP and PVR functional capacity was not worse than in patients with IpcPH. In patients with PH due to left heart disease an elevated RA/LA ratio may indicate CpcPH and invasive diagnostic work-up should be considered.