{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T15:13:43Z","timestamp":1774624423425,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["106796"],"award-info":[{"award-number":["106796"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100003979","name":"NEDA","doi-asserted-by":"crossref","award":["1055214"],"award-info":[{"award-number":["1055214"]}],"id":[{"id":"10.13039\/100003979","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100003979","name":"NEDA","doi-asserted-by":"crossref","award":["11358940"],"award-info":[{"award-number":["11358940"]}],"id":[{"id":"10.13039\/100003979","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Janssen"},{"name":"National Health and Medical Research Council of Australia"},{"name":"Novartis Pharmaceuticals"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,11,12]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Pulmonary hypertension (PHT) appears to be very common in heart failure with preserved ejection fraction but details on its prevalence, severity and prognostic implications have not been well defined. We, therefore, aimed to document PHT and its impact on mortality among adults with left ventricular (LV) diastolic dysfunction (LVDD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed the profile and outcomes of 16\u2009058 adults with LVDD (and with preserved LV ejection fraction, &gt;50%) from the National Echocardiography Database of Australia. Subjects were classified according to their peak tricuspid regurgitation velocity (TRV), reflecting PHT risk, and we then evaluated the relationship between conventional thresholds of increasing risk of PHT and subsequent mortality, during median follow-up of 3.1 (IQR 1.6\u20135.2) years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean age was 73\u00b112\u2009years and 9216 (57.4%) were female. Overall, 2611 (16.3%) had normal TRV levels (&lt;2.5 m\/s) indicative of no PHT, compared with 3471 (21.6%), 8450 (52.6%) and 1526 (9.5%) with TRV levels indicative of borderline (2.5\u20132.8 m\/s), intermediate (2.9\u20133.4 m\/s) and high-risk for PHT (&gt;3.4 m\/s). The 1-year and 5-year actuarial mortality (1701\/1546 and 4232\/8445 deaths, respectively) increased from 6.5% and 34.0% to 27.7% and 78.5%, respectively (p&lt;0.0001), from normal to severely elevated TRV. Adjusted risk (HR) of mortality increased 1.28-fold (95% CI 1.15 to 1.41), 1.51-fold (95% CI 1.38 to 1.65) and 3.47-fold (95% CI 3.13 to 3.85) in those with borderline, intermediate and high risk of PHT versus normal TRV. This observation persisted when excluding atrial fibrillation cases, and when male and female cohorts were assessed separately. Mortality rates increased perceptibly at the second decile distribution of TRV (2.37\u20132.55 m\/s) with a marked increase in mortality from the fifth decile (2.91\u20133.00 m\/s) upwards.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>We demonstrate the negative prognostic impact of elevated TRV levels in many adults with isolated LVDD. A threshold of increased mortality was observed at TRV levels equivalent to \u2018borderline risk\u2019 of PHT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>ACTRN12617001387314<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-003049","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T22:17:09Z","timestamp":1733264229000},"page":"e003049","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence and prognostic significance of pulmonary hypertension in adults with left ventricular diastolic dysfunction"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4260-2793","authenticated-orcid":false,"given":"Seshika","family":"Ratwatte","sequence":"first","affiliation":[{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Playford","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-7119","authenticated-orcid":false,"given":"Geoff","family":"Strange","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia"},{"name":"Heart Research Institute Ltd, Newtown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S","family":"Celermajer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Heart Research Institute Ltd, Newtown, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Stewart","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia"},{"name":"University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025081710400049000_11.2.e003049.1","first-page":"2869","article-title":"Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research","volume":"38","author":"Hoeper","year":"2017","journal-title":"Eur Heart J"},{"key":"2025081710400049000_11.2.e003049.2","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","article-title":"A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010","volume":"175","author":"Gerber","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2025081710400049000_11.2.e003049.3","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa253"},{"key":"2025081710400049000_11.2.e003049.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.051"},{"key":"2025081710400049000_11.2.e003049.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000887"},{"key":"2025081710400049000_11.2.e003049.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.02.039"},{"key":"2025081710400049000_11.2.e003049.7","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01897-2018","article-title":"Pulmonary hypertension due to left heart disease","volume":"53","author":"Vachi\u00e9ry","year":"2019","journal-title":"Eur Respir J"},{"key":"2025081710400049000_11.2.e003049.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000823"},{"key":"2025081710400049000_11.2.e003049.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.06.069"},{"key":"2025081710400049000_11.2.e003049.10","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.009729","article-title":"Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta-Analysis","volume":"7","author":"Kolte","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025081710400049000_11.2.e003049.11","unstructured":"Humbert M , Kovacs M , Hoeper M , et al . ESC\/ERS Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases. Guidelines for the diagnosis and treatment of pulmonary hypertension: Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J 2022."},{"key":"2025081710400049000_11.2.e003049.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.482"},{"key":"2025081710400049000_11.2.e003049.13","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00832-2021","article-title":"Mild pulmonary hypertension and premature mortality among 154\u200a956 men and women undergoing routine echocardiography","volume":"59","author":"Stewart","year":"2022","journal-title":"Eur Respir J"},{"key":"2025081710400049000_11.2.e003049.14","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020207"},{"key":"2025081710400049000_11.2.e003049.15","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.jchf.2024.01.016","article-title":"Association of Pulmonary Artery Pressures With Mortality in Adults With Reduced Left Ventricular Ejection Fraction","volume":"12","author":"Ratwatte","year":"2024","journal-title":"JACC Heart Fail"},{"key":"2025081710400049000_11.2.e003049.16","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-322184"},{"key":"2025081710400049000_11.2.e003049.17","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2023-002268","article-title":"Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes","volume":"10","author":"Ratwatte","year":"2023","journal-title":"Open Heart"},{"key":"2025081710400049000_11.2.e003049.18","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2022-322187"},{"key":"2025081710400049000_11.2.e003049.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.11.052"},{"key":"2025081710400049000_11.2.e003049.20","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201503-0529OC"},{"key":"2025081710400049000_11.2.e003049.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.07.001"},{"key":"2025081710400049000_11.2.e003049.22","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew082"},{"key":"2025081710400049000_11.2.e003049.23","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2047"},{"key":"2025081710400049000_11.2.e003049.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.004"},{"key":"2025081710400049000_11.2.e003049.25","doi-asserted-by":"publisher","DOI":"10.1378\/chest.126.4.1313"},{"key":"2025081710400049000_11.2.e003049.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(85)80477-0"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2024-003049","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:40:12Z","timestamp":1755452412000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2024-003049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,12,3]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/openhrt-2024-003049"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2024-003049","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}