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

Jessie van Wezenbeek; Azar Kianzad; Arno van de Bovenkamp; Jeroen Wessels; Sophia A Mouratoglou; Natalia J Braams; Samara M A Jansen; Eva Meulblok; Lilian J Meijboom; J Tim Marcus; Anton Vonk Noordegraaf; Marie José Goumans; Harm Jan Bogaard; M Louis Handoko; Frances S de Man

doi:10.1161/CIRCHEARTFAILURE.121.008726

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

Jessie van Wezenbeek
, Azar Kianzad
, Arno van de Bovenkamp
, Jeroen Wessels
, Sophia A Mouratoglou
, Natalia J Braams
, Samara M A Jansen
, Eva Meulblok
, Lilian J Meijboom
, J Tim Marcus
, Anton Vonk Noordegraaf
, Marie José Goumans
, Harm Jan Bogaard
, M Louis Handoko
, Frances S de Man

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	e008726
Journal	Circulation. Heart failure
Volume	15
Issue number	2
DOIs	https://doi.org/10.1161/CIRCHEARTFAILURE.121.008726
Publication status	Published - Feb 2022
Externally published	Yes

Keywords

Adult
Aged
Cardiac Catheterization/methods
Female
Heart Atria/physiopathology
Heart Failure/physiopathology
Heart Ventricles/physiopathology
Humans
Hypertension, Pulmonary/physiopathology
Male
Middle Aged
Pulmonary Arterial Hypertension/physiopathology
Stroke Volume/physiology
Ventricular Dysfunction, Right/physiopathology
Ventricular Function, Left/physiology
Ventricular Function, Right/physiology

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van Wezenbeek, J., Kianzad, A., van de Bovenkamp, A., Wessels, J., Mouratoglou, S. A., Braams, N. J., Jansen, S. M. A., Meulblok, E., Meijboom, L. J., Marcus, J. T., Vonk Noordegraaf, A., José Goumans, M., Jan Bogaard, H., Handoko, M. L., & de Man, F. S. (2022). 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, 15(2), e008726. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008726

van Wezenbeek, Jessie ; Kianzad, Azar ; van de Bovenkamp, Arno et al. / 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. In: Circulation. Heart failure. 2022 ; Vol. 15, No. 2. pp. e008726.

@article{9c06bc0b40164e70b18d92374810c030,

title = "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",

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.",

keywords = "Adult, Aged, Cardiac Catheterization/methods, Female, Heart Atria/physiopathology, Heart Failure/physiopathology, Heart Ventricles/physiopathology, Humans, Hypertension, Pulmonary/physiopathology, Male, Middle Aged, Pulmonary Arterial Hypertension/physiopathology, Stroke Volume/physiology, Ventricular Dysfunction, Right/physiopathology, Ventricular Function, Left/physiology, Ventricular Function, Right/physiology",

author = "\{van Wezenbeek\}, Jessie and Azar Kianzad and \{van de Bovenkamp\}, Arno and Jeroen Wessels and Mouratoglou, \{Sophia A\} and Braams, \{Natalia J\} and Jansen, \{Samara M A\} and Eva Meulblok and Meijboom, \{Lilian J\} and Marcus, \{J Tim\} and \{Vonk Noordegraaf\}, Anton and \{Jos{\'e} Goumans\}, Marie and \{Jan Bogaard\}, Harm and Handoko, \{M Louis\} and \{de Man\}, \{Frances S\}",

year = "2022",

month = feb,

doi = "10.1161/CIRCHEARTFAILURE.121.008726",

language = "English",

volume = "15",

pages = "e008726",

journal = "Circulation. Heart failure",

issn = "1941-3289",

publisher = "Lippincott Williams \& Wilkins",

number = "2",

}

van Wezenbeek, J, Kianzad, A, van de Bovenkamp, A, Wessels, J, Mouratoglou, SA, Braams, NJ, Jansen, SMA, Meulblok, E, Meijboom, LJ, Marcus, JT, Vonk Noordegraaf, A, José Goumans, M, Jan Bogaard, H, Handoko, ML & de Man, FS 2022, '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, no. 2, pp. e008726. https://doi.org/10.1161/CIRCHEARTFAILURE.121.008726

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. / van Wezenbeek, Jessie; Kianzad, Azar; van de Bovenkamp, Arno et al.
In: Circulation. Heart failure, Vol. 15, No. 2, 02.2022, p. e008726.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Right Ventricular and Right Atrial Function Are Less Compromised in Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction

T2 - A Comparison With Pulmonary Arterial Hypertension With Similar Pressure Overload

AU - van Wezenbeek, Jessie

AU - Kianzad, Azar

AU - van de Bovenkamp, Arno

AU - Wessels, Jeroen

AU - Mouratoglou, Sophia A

AU - Braams, Natalia J

AU - Jansen, Samara M A

AU - Meulblok, Eva

AU - Meijboom, Lilian J

AU - Marcus, J Tim

AU - Vonk Noordegraaf, Anton

AU - José Goumans, Marie

AU - Jan Bogaard, Harm

AU - Handoko, M Louis

AU - de Man, Frances S

PY - 2022/2

Y1 - 2022/2

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Cardiac Catheterization/methods

KW - Female

KW - Heart Atria/physiopathology

KW - Heart Failure/physiopathology

KW - Heart Ventricles/physiopathology

KW - Humans

KW - Hypertension, Pulmonary/physiopathology

KW - Male

KW - Middle Aged

KW - Pulmonary Arterial Hypertension/physiopathology

KW - Stroke Volume/physiology

KW - Ventricular Dysfunction, Right/physiopathology

KW - Ventricular Function, Left/physiology

KW - Ventricular Function, Right/physiology

U2 - 10.1161/CIRCHEARTFAILURE.121.008726

DO - 10.1161/CIRCHEARTFAILURE.121.008726

M3 - Article

C2 - 34937392

SN - 1941-3289

VL - 15

SP - e008726

JO - Circulation. Heart failure

JF - Circulation. Heart failure

IS - 2

ER -

van Wezenbeek J, Kianzad A, van de Bovenkamp A, Wessels J, Mouratoglou SA, Braams NJ et al. 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. 2022 Feb;15(2):e008726. doi: 10.1161/CIRCHEARTFAILURE.121.008726