Contemporary pulmonary hypertension hemodynamic definitions stratify mortality risk in candidates for advanced heart failure therapies

Right heart catheterization (RHC) is performed to evaluate pulmonary hypertension (PH) in patients with Stage C-D chronic heart failure (HF) being considered for advanced therapies. However, the recommended thresholds of hemodynamic criteria at which to test PH reversibility (e.g., pulmonary artery systolic pressure (PASP) ≥50 mmHg) are relatively high, [1] considering that mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) are very low in healthy adults, [2, 3] and mortality increases with even mild PH. [4, 5] Contemporary guidelines have thus set the mPAP threshold for PH diagnosis at 20 mmHg, and reduced the PVR threshold indicating a pre-capillary component to 2 WU. [6–8] As a step toward incorporating current PH guidelines into advanced HF care, we grouped patients in our Canadian center by PH severity using specific criteria prompting reversibility testing and the broader hemodynamic definition. We then tested whether these PH groups were associated with 3-year mortality.