Diffusion Capacity and Mortality in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction

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).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.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.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 (DLCO45%, low DLCO; n = 52) and patients with a DLCO ≥45% of the predicted value (DLCO≥45%; n = 56). DLCO45% 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 DLCO45% 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 DLCO45% as an independent predictor of death (hazard ratio: 6.6; 95% CI: 2.6 to 16.9; p 0.001).In patients with PH-HFpEF, a low DLCO is strongly associated with mortality.