Right Ventricular and Right Atrial Function Are Less Compromised in Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction: A Comparison With Pulmonary Arterial Hypertension With Similar Pressure Overload

Circulation Heart Failure, vol. 15, pp. e008726

Abstract

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a prevalent disorder for which no effective treatment yet exists. Pulmonary hypertension (PH) and right atrial (RA) and ventricular (RV) dysfunction are frequently observed. The question remains whether the PH with the associated RV/RA dysfunction in HFpEF are markers of disease severity. METHODS: To obtain insight in the relative importance of pressure-overload and left-to-right interaction, we compared RA and RV function in 3 groups: 1. HFpEF (n=13); 2. HFpEF-PH (n=33), and; 3. pulmonary arterial hypertension (PAH) matched to pulmonary artery pressures of HFpEF-PH (PH limited to mPAP ≥30 and ≤50 mmHg) (n=47). Patients underwent right heart catheterization and cardiac magnetic resonance imaging. RESULTS: The right ventricle in HFpEF-PH was less dilated and hypertrophied than in PAH. In addition, RV ejection fraction was more preserved (HFpEF-PH: 52±11 versus PAH: 36±12%). RV filling patterns differed: vena cava backflow during RA contraction was observed in PAH only. In HFpEF-PH, RA pressure was elevated throughout the cardiac cycle (HFpEF-PH: 10 [8-14] versus PAH: 7 [5-10] mm Hg), while RA volume was smaller, reflecting excessive RA stiffness (HFpEF-PH: 0.14 [0.10-0.17] versus PAH: 0.08 [0.06-0.11] mm Hg/mL). RA stiffness was associated with an increased eccentricity index (HFpEF-PH: 1.3±0.2 versus PAH: 1.2±0.1) and interatrial pressure gradient (9 [5 to 12] versus 2 [-2 to 5] mm Hg). CONCLUSIONS: RV/RA function was less compromised in HFpEF-PH than in PAH, despite similar pressure-overload. Increased RA pressure and stiffness in HFpEF-PH were explained by left atrial/RA-interaction. Therefore, our results indicate that increased RA pressure is not a sign of overt RV failure but rather a reflection of HFpEF-severity.

Authors 15

1. Jessie van Wezenbeek

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Jessie van Wezenbeek https://orcid.org/0000-0002-1091-5445 Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

2. Azar Kianzad

   ORCID

   Affiliation as printed

   Azar Kianzad https://orcid.org/0000-0003-1238-4139

3. Arno A. van de Bovenkamp

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Cardiology (A.v.d.B., M.L.H.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Arno van de Bovenkamp https://orcid.org/0000-0002-7994-7525 Cardiology (A.v.d.B., M.L.H.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

4. Jeroen N. Wessels
   Affiliation as printed

   Jeroen Wessels https://orcid.org/0000-0003-2401-7707

5. Sophia‐Anastasia Mouratoglou

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Sophia A. Mouratoglou https://orcid.org/0000-0001-7804-8352 Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

6. Natalia Joanna Braams

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Natalia J. Braams https://orcid.org/0000-0001-8541-6088 Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

7. Samara M. A. Jansen

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Samara M.A. Jansen https://orcid.org/0000-0003-3493-3573 Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

8. Eva Meulblok

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Eva Meulblok Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

9. Lilian J. Meijboom

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

   Affiliation as printed

   Radiology and Nuclear Medicine (L.J.M., J.T.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

   Lilian J. Meijboom https://orcid.org/0000-0002-7528-8307 Radiology and Nuclear Medicine (L.J.M., J.T.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

10. Johannes Tim Marcus

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

    Affiliation as printed

    Radiology and Nuclear Medicine (L.J.M., J.T.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

    J. Tim Marcus https://orcid.org/0000-0001-9948-6407 Radiology and Nuclear Medicine (L.J.M., J.T.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

11. Anton Vonk Noordegraaf

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

    Affiliation as printed

    Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

    Anton Vonk Noordegraaf https://orcid.org/0000-0002-4057-758X Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

12. Marie‐José Goumans Aachen Department of Cell and Chemical Biology

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Cell and Chemical Biology, Leiden University Medical Centre, the Netherlands (M.J.G.)

13. Harm Jan Bogaard

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

    Harm Jan Bogaard https://orcid.org/0000-0001-5371-0346 Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

14. M. Louis Handoko

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Cardiology (A.v.d.B., M.L.H.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

    M. Louis Handoko https://orcid.org/0000-0002-8942-7865 Cardiology (A.v.d.B., M.L.H.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands

15. Frances S. de Man

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences · Vrije Universiteit Amsterdam

    Affiliation as printed

    Departments of Pulmonary Medicine (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.), Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands