Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance - 08/04/19
Abstract |
Background |
The clinical characteristics, hemodynamic changes and outcomes of lung disease-associated pulmonary hypertension (LD-PH) are poorly defined.
Methods |
A prospective cohort of PH patients undergoing initial hemodynamic assessment was collected, from which 51 patients with LD-PH were identified. Baseline characteristics and long-term survival were compared with 83 patients with idiopathic pulmonary arterial hypertension (iPAH).
Results |
Mean age (±standard deviation) of LD-PH patients was 64 ± 10 years, 30% were female and 78% were New York Heart Association class III-IV. The LD-PH group was older than the iPAH group (64 ± 10 vs 56 ± 18 years, respectively, P = 0.003) with a lower percentage of women (30% vs 70%, P = 0.007). LD-PH patients had smaller right ventricular sizes (P = 0.02) and less tricuspid regurgitation (P = 0.03) by echocardiogram, and lower mean pulmonary arterial pressures (mPAP) (P = 0.01) and pulmonary vascular resistance (PVR) (P = 0.001) at catheterization. Despite these findings, mortality was equally high in both groups (P = 0.16). 5-year survival was lower in patients with interstitial lung disease compared to those with obstructive pulmonary disease (P = 0.05). Among the LD-PH population, those with mild to moderately elevated mPAP and those with PVR <7 Wood units demonstrated significantly improved survival (P = 0.04 and P = 0.001, respectively). Vasoreactivity was not associated with improved survival (P = 0.64). A PVR ≥7 Wood units was associated with increased risk of mortality (hazard ratio (95% confidence interval), 3.59 (1.27–10.19), P = 0.02).
Conclusions |
Despite less severe PH and less right heart sequelae, LD-PH has an equally poor clinical outcome when compared to iPAH. A PVR ≥7 Wood units in LD-PH patients was associated with 3-fold higher mortality.
Le texte complet de cet article est disponible en PDF.Highlights |
• | LD-PH patients have equally poor survival as iPAH, despite less severe echocardiographic findings and hemodynamics at cath. |
• | Among LD-PH patients, patients with ILD had significant worse 5-survival compared to those with COPD. |
• | Vasoreactivity was not associated with improved survival. |
• | A PVR≥7 Wood units was associated with a 3-fold higher mortality. |
Abbreviations : COPD, ILD, iPAP, IPF, LD-PH, mPAP, NYHA, PAH, PH, PVR, RV, TR, WHO
Plan
| ☆ | RK is a consultant for, and receives research funding from, Actelion Pharmaceuticals. He also serves as an investigator for Abbott and Edwards Lifesciences and is an unpaid member of the scientific advisory board for Ventripoint. JA, KS, JL, KP and MF have no conflicts of interest to disclose. |
| ☆☆ | This work was presented at the 2018 American College of Cardiology Scientific Sessions, Orlando, FL, March 10–12. |
Vol 150
P. 126-130 - avril 2019 Retour au numéro
Article précédent
- The natural history of non-cavitary nodular bronchiectatic Mycobacterium avium complex lung disease
- Byoung Soo Kwon, Jun Hee Lee, Younsuck Koh, Woo-Sung Kim, Jin-Woo Song, Yeon-Mok Oh, Sang-Do Lee, Sei Won Lee, Jae-Seung Lee, Chae-Man Lim, Chang-Min Choi, Jin-Won Huh, Sang-Bum Hong, Tae Sun Shim, Kyung-Wook Jo
- Use of red cell distribution width in a population at high risk for pulmonary hypertension
- Laura A. Petrauskas, Lesley Ann Saketkoo, Thomas Kazecki, Shigeki Saito, Vijay Jaligam, Bennett P. deBoisblanc, Matthew R. Lammi
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?