Pathophysiological Bases of Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction and Implications for Management

Prevalence, definition, and diagnosis

The prevalence of PH in patients with HFpEF is widely heterogeneous, with frequencies ranging from 36% to 81%, and this is due to the diagnostic means used, to the time of progression of the underlying disease, and to the different ejection fraction cut-off points used to define HFpEF. For example, in a subanalysis of the PARAGON study, the prevalence of PH in patients with HFpEF was 31%. Moreover, the different phenotypes of HFpEF may present with a lower or higher degree of PH, depending on the increase in pulmonary vascular resistance, the increase in right atrial pressure, and associated concomitant chronic kidney disease.

Group 2 PH is defined as mean pulmonary artery pressure > 20 mmHg and pulmonary capillary pressure > 15 mmHg. Right heart catheterization is considered the gold standard for accurate measurement of pulmonary pressures, and it is valuable in evaluation of the hemodynamic response to physical exertion, providing important information for differentiating between group 2 PH and other etiologies.

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