Factors associated with elevated pulmonary vascular resistance in ambulatory patients with end-stage heart failure accepted for heart transplant

INTRODUCTION Pulmonary hypertension (PH) is a common complication of heart failure (HF) that results in worse prognosis and heart complications following heart transplantation. To better define and understand left-sided PH, it is necessary to integrate the clinical context, noninvasive assessment, and invasive hemodynamic variables. OBJECTIVES The aim of the study was to search for noninvasive factors related to the presence of PH with elevated pulmonary vascular resistance (PVR) in patients with advanced HF. PATIENTS AND METHODS The study is a retrospective analysis of 282 patients with end-stage HF accepted for transplantation in the cardiology department between 2016 and 2018. A panel of laboratory tests, echocardiography, ergospirometry, and right heart catheterization were performed in all included patients. The Model for End-Stage Liver Disease Excluding INR (MELD-XI) and the Heart Failure Survival Score (HFSS) were calculated according to the appropriate formulas. RESULTS The median age was 57 (51-60) years and 87.6% of patients were men. Pulmonary hypertension with elevated PVR was found in 30.1% of patients. The multivariable logistic regression analysis confirmed that lower HFSS (OR, 0.59; 95% CI, 0.383-0.908; P = 0.016), and higher MELD-XI scores (OR, 1.13; 95% CI, 1.024-1.24; P = 0.014), as well as higher alkaline phosphatase levels (OR, 1.02; 95% CI, 1.007-1.024; P <0.001) were independent factors associated with increased PVR. CONCLUSIONS To the best of our knowledge, this is the first study to demonstrate that high MELD-XI and low HFFS scores, as well as high alkaline phosphatase serum concentrations were independently associated with increased PVR in patients with advanced HF referred for transplantation.