Cardiovascular Journal of Africa: Vol 30 No 1 (January/February 2019)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019

AFRICA

between PH and DCM among HF subjects in south-western

Nigeria. However, in a similar study, Karaye

et al

did not find

a significant association between PH and both HF aetiologies,

perhaps due to the smaller sample of 80 patients enrolled in

their study. The frequency of subjects with a DCM echo pattern

was also significantly higher in the PH group compared with the

non-PH group. The higher frequency of DCM or a DCM echo

morphology observed in PH subjects might have been due to the

restrictive diastolic physiology associated with high LV filling

pressures commonly seen in these patients.

Among our HF population, we did not find an independent

relationship between clinical parameters and PASP. This was

also reported in a similar study among a mixed HF population.

The key echocardiographic factors implicated in the

development of PH in HF patients are left heart variables

associated with increased pulmonary venous pressure.

These

factors include markers of elevated LV filling pressure and

parameters of MR, as demonstrated by most studies.

1,2,5-7

This

has been further confirmed in the present study in which

echocardiographic markers of elevated LV filling pressures and

diastolic function, LAVI and E/e

′

ratio correlated significantly

and positively with PASP on both univariate and multivariate

analyses. This suggests that worsening LV diastolic function and

increasing LV filling pressures are independently associated with

increasing PASP.

Mitral regurgitant volume correlated positively with PASP.

This suggests that worsening MR in the study population was

associated with increasing pulmonary artery pressures. However,

this finding was not significant on multivariate analysis. Chronic

mitral regurgitation results in maladaptive increases in LV

dimension, increase in systolic wall stress, progressive decline

in LV contractile function, elevation of left atrial pressure, and

therefore worsening PH.

The relationship between LVEF and PH is less clear in

view of the conflicting data reported in various studies.

1,2,5,6,14,30

In this study, LVEF correlated negatively with PASP. This

suggests that worsening LV systolic function was associated

with increasing PASP. The association of worsening LVEF and

PH is likely to be seen in studies of isolated or predominant

HFrEF populations.

5,6,30

The present study had a predominant

HFrEF frequency of 66.7%. Other studies

5,6

that did not find a

significant association had isolated or a significant number of

HFpEF subjects.

PH of any cause is associated with compensatory and

maladaptive changes of the right heart.

4,31

In this study, all the

parameters of RV structure (RV basal and RV wall thickness

dimensions) and function (TAPSE and eccentricity index)

correlated significantly with PASP. This finding highlights the

importance of properly assessing the right side of the heart,

which can help to characterise patients with borderline Doppler-

derived pulmonary artery pressure measurements.

8,9

Conclusion

PH is a fairly common condition among HF subjects, occurring

in over a third of this study. Its presence in our HF population

was significantly associated with higher LV filling pressures,

more severe MR, poorer LV systolic function and worse RV

remodelling. Echocardiographic screening for pulmonary

hypertension should be done in all HF patients in order to

identify those at high risk who require aggressive optimisation of

standard therapy, as recommended by guidelines.

The authors thank our cardiovascular laboratory nurses, Matron Phil-Enemosa

and Sister Eke, for their assistance in preparing patients for echocardiography.

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