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Pulmonary hypertension related to heart and lung disease has the worst prognosis compared to the others forms including pulmonary arterial hypertension
Topic 6 - Hypertension Conclusion We noted that despite improved dyspnoea and quality of life in these patients, the prognosis of patients undergoing Eisenmenger treatment under PAH specific therapy remains reserved. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.02.051 334
Pulmonary hypertension related to heart and lung disease has the worst prognosis compared to the others forms including pulmonary arterial hypertension C. Fauvel 1,∗ , O. Raitiere 1 , H. Chopra 1 , P. Guignant 1 , N. Si Belkacem 1 , N. Bouhzam 1 , C. Tron 1 , E. Artaud Macari 2 , C. Viacroze 2 , D. Schleifer 2 , S. Dominique 2 , E. Durand 3 , H. Eltchaninoff 3 , F. Bauer 4 1 Department of Cardiology, FHU REMOD-VHF 2 Department of pneumology 3 Department of Cardiology, FHU REMOD-VHF, Normandie Univ, UNIROUEN, Inserm U1096 4 Pulmonary Hypertension Referral Center 27/76, Department of Cardiology, FHU REMOD-VHF, Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Rouen, France ∗ Corresponding author. E-mail address: charles [email protected] (C. Fauvel) Background Pulmonary hypertension (PH) still has a poor prognosis. To prioritize effort in detection and management of PH, it is important to point out which of the 5 phenotypes has the worst prognosis and must retain our attention. Purpose To compare the prognostic significance of each forms of PH in a prospective regional cohort from a referral center. Methods In total, 328 patients (age = 63.4 ± 14 year-old, 47% of male) were prospectively included from 2002 to 2017, after right heart catheterisation if they had mean pulmonary artery pressure > 25 and > 35 mmHg for those with PH related to lung disease. PH patients with left heart disease, only those with diastolic or transpulmonary pressure gradient > 7 or > 12 mmHg respectively, were analysed. Patients were routinely followed-up after therapeutic optimisation. Five-year survival rate was then compared using the log-rank test and adjusted hazard ratio (HR).
205 Results In total, 74% patients were in NYHA class 3—4. The 6-min walking test averaged 294 ± 139 m, the NTproBNP was increased up to 2990 ± 5894 pg/l. Mean pulmonary artery pressure was 43.3 ± 12.8 mmHg and cardiac index was 2.95 ± 0.91 L/min/m2 . Right atrial pressure and pulmonary vascular resistance averaged 9.5 ± 5.9 mmHg and 6.5 ± 3.8 WU, respectively. 138 patients (42%) belonged to the pulmonary arterial hypertension group (PAH), 53 (16%) to left heart disease group (LHD-PH) while 47 (14%) were associated to lung disease (LD-PH). Chronic thromboembolic PH (CTPH) was found in 71 patients (22%) and 19 patients (6%) had unclassified PH (U-PH). The 5-year survival rate was 75% (PAH), 70% (LHD-PH), 62% (LD-PH), 85% (CTPH), and 79% (U-PH), giving a log-rank P < 0.001, and adjusted HR of 2.43 95%CI (1.24—4.73) for LHD-PH and 2.95 95%CI (1.43—6.07) for LD-PH (Fig. 1). Conclusion PH related to left heart disease and lung disease had 2-fold and 3-fold increase in mortality, respectively, compared with others forms of PH including PAH. Thereby, efforts should concentrate on those two prevalent phenotypes.
Fig. 1
Five years survival rate comparison.
Disclosure of interest peting interest
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.02.052
Pulmonary hypertension related to heart and lung disease has the worst prognosis compared to the others forms including pulmonary arterial hypertension C. Fauvel 1,∗ , O. Raitiere 1 , H. Chopra 1 , P. Guignant 1 , N. Si Belkacem 1 , N. Bouhzam 1 , C. Tron 1 , E. Artaud Macari 2 , C. Viacroze 2 , D. Schleifer 2 , S. Dominique 2 , E. Durand 3 , H. Eltchaninoff 3 , F. Bauer 4 1 Department of Cardiology, FHU REMOD-VHF 2 Department of pneumology 3 Department of Cardiology, FHU REMOD-VHF, Normandie Univ, UNIROUEN, Inserm U1096 4 Pulmonary Hypertension Referral Center 27/76, Department of Cardiology, FHU REMOD-VHF, Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Rouen, France ∗ Corresponding author. E-mail address: charles [email protected] (C. Fauvel) Background Pulmonary hypertension (PH) still has a poor prognosis. To prioritize effort in detection and management of PH, it is important to point out which of the 5 phenotypes has the worst prognosis and must retain our attention. Purpose To compare the prognostic significance of each forms of PH in a prospective regional cohort from a referral center. Methods In total, 328 patients (age = 63.4 ± 14 year-old, 47% of male) were prospectively included from 2002 to 2017, after right heart catheterisation if they had mean pulmonary artery pressure > 25 and > 35 mmHg for those with PH related to lung disease. PH patients with left heart disease, only those with diastolic or transpulmonary pressure gradient > 7 or > 12 mmHg respectively, were analysed. Patients were routinely followed-up after therapeutic optimisation. Five-year survival rate was then compared using the log-rank test and adjusted hazard ratio (HR).
205 Results In total, 74% patients were in NYHA class 3—4. The 6-min walking test averaged 294 ± 139 m, the NTproBNP was increased up to 2990 ± 5894 pg/l. Mean pulmonary artery pressure was 43.3 ± 12.8 mmHg and cardiac index was 2.95 ± 0.91 L/min/m2 . Right atrial pressure and pulmonary vascular resistance averaged 9.5 ± 5.9 mmHg and 6.5 ± 3.8 WU, respectively. 138 patients (42%) belonged to the pulmonary arterial hypertension group (PAH), 53 (16%) to left heart disease group (LHD-PH) while 47 (14%) were associated to lung disease (LD-PH). Chronic thromboembolic PH (CTPH) was found in 71 patients (22%) and 19 patients (6%) had unclassified PH (U-PH). The 5-year survival rate was 75% (PAH), 70% (LHD-PH), 62% (LD-PH), 85% (CTPH), and 79% (U-PH), giving a log-rank P < 0.001, and adjusted HR of 2.43 95%CI (1.24—4.73) for LHD-PH and 2.95 95%CI (1.43—6.07) for LD-PH (Fig. 1). Conclusion PH related to left heart disease and lung disease had 2-fold and 3-fold increase in mortality, respectively, compared with others forms of PH including PAH. Thereby, efforts should concentrate on those two prevalent phenotypes.
Fig. 1
Five years survival rate comparison.
Disclosure of interest peting interest
The authors declare that they have no com-
https://doi.org/10.1016/j.acvdsp.2019.02.052