Revised definition of pulmonary hypertension subtypes enhances prognostic stratification in hospitalized heart failure patients.

Background: Pulmonary hypertension (PH) is a common complication of heart failure (HF) that has two subtypes: isolated postcapillary PH (IpcPH) and combined postcapillary and precapillary PH (CpcPH). The definitions of these subtypes were revised in 2022, but the prognostic impacts of this change in hospitalized patients with HF remain unclear. Therefore, this study aimed to investigate how the current definitions of PH subtypes affect patient prognosis.

Methods: Among 4,762 patients in the West Tokyo Heart Failure 2 registry, we analyzed 975 patients (age: 69 ± 14 years; 33% female). We analyzed patients who underwent right heart catheterization following clinical stabilization. Patients were divided into NonPH, IpcPH, or CpcPH groups according to the 2018 and 2022 definitions. We assessed the impact of PH subtypes on adverse events, defined as cardiac mortality or HF rehospitalization among those hospitalized for HF.

Results: The proportion of patients with CpcPH increased to 34.8% in 2022 (from 19.8% under the 2018 definition). The 2018 definition stated that CpcPH and IpcPH were associated with an increased risk of the adverse events (CpcPH: HR 1.62, 95%CI 1.14-2.31; IpcPH: HR 1.50, 95%CI 1.07-2.10). However, according to the 2022 definition, only CpcPH was an independent risk factor for the adverse events (CpcPH: HR 1.75, 95%CI 1.30-2.36; IpcPH: HR 1.03, 95%CI 0.64-1.65).

Conclusions: The prognostic impact of CpcPH was more evident with the 2022 definition among hospitalized patients with HF. This information will help create more personalized disease management strategies.