Impact of Lipid Profile Alterations on the Right Heart Function and Prognosis in Pre-Capillary Pulmonary Hypertension Patients: A Prospective Cohort Study.

BACKGROUND AND

OBJECTIVE

The impact of lipid abnormalities on right heart function and outcomes in pre-capillary pulmonary hypertension (precPH) remains unclear. This study investigates how lipid profile alterations influence right heart function, strain, and prognosis in precPH patients.

METHODS

From June 2013 to December 2023, 394 precPH patients were prospectively enrolled. Clinical data, cardiac MRI-derived right heart systolic function, and strain parameters were compared among groups based on lipid profiles. The optimal cut-off values of lipid profiles were determined using the maximally selected rank statistics. Prognostic analyses were conducted using Cox regression and Kaplan-Meier survival methods.

RESULTS

During a median follow-up of 36 months, 18.8% of patients died. Low-density lipoprotein cholesterol (LDL-C) < 1.93 mmol/L and high-density lipoprotein cholesterol (HDL-C) < 0.82 mmol/L were associated with increased mortality risks (2.51-fold and 2.65-fold, respectively). Multivariate analysis confirmed decreased LDL-C (HR 1.853, 95% CI 1.102-3.115, p = 0.02) and decreased HDL-C (HR 2.019, 95% CI 1.131-3.603, p = 0.02) as independent prognostic indicators. A decrease in either cholesterol subtype predicted worse outcomes (Log-rank p = 0.003). Incorporation of LDL-C and HDL-C enhanced prognostic accuracy of the ESC model (χ2: 50.8 to 60.5, p = 0.007; 50.8 to 66.0, p < 0.001) and ESC-CMR model (χ2: 59.3 to 66.0, p = 0.04; 59.3 to 72.7, p = 0.001). HDL-C < 0.82 mmol/L was associated with impaired right ventricular global longitudinal strain (p < 0.001), RV free wall strain (p < 0.001), and right atrial phasic strain (all p < 0.05).

CONCLUSIONS

Decreased HDL-C and LDL-C levels independently predict increased mortality in precPH patients. Notably, low HDL-C significantly associates with impaired right heart function and strain.

TRIAL REGISTRATION: Chinese Clinical Trial Registry (https://www.

CLINICALTRIALS: gov; ID: ChiCTR1800019314 and ChiCTR1900025518).