The Prevalence of Pulmonary Hypertension in Left Heart Disease in Austria, Germany and Switzerland (DACH Region)

<bold>Background:</bold> Pulmonary hypertension (PH) increases mortality, and often complicates left heart disease (LHD). Comprehensive PH prevalence estimates in heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF), aortic stenosis (AS) and mitral regurgitation (MR) are lacking, but may have direct implications on population health initiatives. <bold>Methods:</bold> Using PRISMA guidelines, we searched Pubmed (MEDLINE) between 1945-2023 for studies including patients with LHD from the DACH region (Austria, Germany, Switzerland). Studies reporting on 1) PH prevalence, 2) systolic pulmonary arterial pressure (PAP) from echocardiography (ECHO, defined >35mmHg) or 3) mean PAP from right heart catheterization (RHC, defined >20mmHg) were included in our meta-analysis. <bold>Results:</bold> From N=127 studies including N=56,301 patients, there were N=34, N=17, N=39, and N=37 studies focusing on HFrEF, HFpEF, AS and MR, which included N=18,460, N=3,405, N=16,985, and N=17,451 patients, respectively. Overall, PH prevalence estimates were significantly greater in studies using RHC vs. ECHO (p<0.001). The pooled RHC-derived PH prevalence for HFrEF, HFpEF and AS were 91%, 94% and 81%, respectively. The pooled ECHO-derived PH prevalence for HFrEF, HFpEF, AS and MR were 67%, 72%, 73% and 80%, respectively (95%CI in Figure 1). Focusing on HFrEF, age significantly affected PH prevalence (p=0.021),while sex did not (p=0.191) <bold>Conclusion:</bold> The prevalence of PH is extremely common in patients with diagnosed LHD in DACH. These data warrant large prospective studies that quantitate the contribution of PH to adverse outcome in LHD, leading to novel public health measures that mitigate risk in this highly morbid disease.