Author + information
- Received November 12, 2015
- Revision received December 7, 2015
- Accepted December 22, 2015
- Published online June 1, 2016.
- Marius M. Hoeper, MD∗ (, )
- Katrin Meyer, MD,
- Jessica Rademacher, MD,
- Jan Fuge, MPH,
- Tobias Welte, MD and
- Karen M. Olsson, MD
- Department of Respiratory Medicine and German Center of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
- ↵∗Reprint requests and correspondence to
: Dr. Marius M. Hoeper, Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, Lower Saxony 30625, Germany.
Objectives This study sought to investigate the prognostic importance of a low diffusion capacity of the lung for carbon monoxide (DLCO) in patients with a catheter-based diagnosis of pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
Background In patients with pulmonary arterial hypertension, a low DLCO is associated with poor outcome. It is unclear whether the same is true in patients with PH-HFpEF.
Methods This study retrospectively analyzed clinical characteristics, smoking history, lung function measurements, chest computed tomography, hemodynamics, and survival in 108 patients with PH-HFpEF. The presence of post-capillary PH was determined by right heart catheterization. Patients with moderate or severe lung function abnormalities were excluded.
Results On the basis of previous studies and receiver-operating characteristic curve analysis, the study cohort was divided into patients with a DLCO <45% of the predicted value (DLCO<45%, low DLCO; n = 52) and patients with a DLCO ≥45% of the predicted value (DLCO≥45%; n = 56). DLCO<45% was associated with male sex (odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.05 to 6.99; p = 0.039) and smoking history (OR: 5.01; 95% CI: 1.91 to 13.10; p < 0.001). There were no correlations between DLCO and other lung function parameters and hemodynamics. Compared with patients with DLCO≥45%, patients with DLCO<45% had a significantly worse outcome (survival rate at 3 years 36.5% vs. 87.8%, p < 0.001 by log-rank analysis). Cox proportional hazard analysis identified DLCO<45% as an independent predictor of death (hazard ratio: 6.6; 95% CI: 2.6 to 16.9; p < 0.001).
Conclusions In patients with PH-HFpEF, a low DLCO is strongly associated with mortality.
The study was funded by the German Center of Lung Research (BREATH/DZL). Dr. Hoeper has received speakers fees and honoraria for consultations from Actelion, Bayer, GlaxoSmithKline, and Pfizer. Dr. Meyer has received speakers fees from GlaxoSmithKline. Dr. Olsson has received speakers fees from Actelion, Bayer, GlaxoSmithKline, Pfizer, and United Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 12, 2015.
- Revision received December 7, 2015.
- Accepted December 22, 2015.
- American College of Cardiology Foundation