Natural history of chronic thromboembolic pulmonary disease with no or mild pulmonary hypertension
Copyright © 2023 International Society for the Heart and Lung Transplantation. All rights reserved..
BACKGROUND: We describe baseline characteristics, disease progression and mortality in chronic thromboembolic pulmonary disease patients as a function of mean pulmonary artery pressure (mPAP) according to new and previous definitions of pulmonary hypertension.
METHODS: All patients diagnosed with chronic thromboembolic pulmonary disease between January, 2015 and December, 2019 were dichotomized according to initial mPAP: ≤ 20 mmHg ('normal') vs 21-24 mmHg ('mildly-elevated'). Baseline features were compared between the groups, and pairwise analysis performed to determine changes in clinical endpoints at 1-year, excluding those who underwent pulmonary endarterectomy or did not attend follow-up. Mortality was assessed for the whole cohort over the entire study period.
RESULTS: One hundred thirteen patients were included; 57 had mPAP ≤ 20 mmHg and 56 had mPAP 21-24 mmHg. Normal mPAP patients had lower pulmonary vascular resistance (1.6 vs 2.5WU, p < 0.01) and right ventricular end-diastolic pressure (5.9 vs 7.8 mmHg, p < 0.01) at presentation. At 3 years, no major deterioration was seen in either group. No patients were treated with pulmonary artery vasodilators. Eight had undergone pulmonary endarterectomy. Over 37 months median follow-up, mortality was 7.0% in the normal mPAP group and 8.9% in the mildly-elevated mPAP group. Cause of death was malignancy in 62.5% of cases.
CONCLUSIONS: Chronic thromboembolic pulmonary disease patients with mild pulmonary hypertension have statistically higher right ventricular end-diastolic pressure and pulmonary vascular resistance than those with mPAP ≤ 20 mmHg. Baseline characteristics were otherwise similar. Neither group displayed disease progression on non-invasive tests up to 3 years. Mortality over 37 months follow-up is 8%, and mainly attributable to malignancy. Further prospective study is required to validate these findings.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 42(2023), 9 vom: 16. Sept., Seite 1275-1285 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Reddy, Sathineni A [VerfasserIn] |
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| Links: |
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| Themen: |
Health outcomes |
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| Anmerkungen: |
Date Completed 14.08.2023 Date Revised 16.08.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2023.04.016 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357042271 |
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| 100 | 1 | |a Reddy, Sathineni A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Natural history of chronic thromboembolic pulmonary disease with no or mild pulmonary hypertension |
| 264 | 1 | |c 2023 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 14.08.2023 | ||
| 500 | |a Date Revised 16.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 International Society for the Heart and Lung Transplantation. All rights reserved. | ||
| 520 | |a BACKGROUND: We describe baseline characteristics, disease progression and mortality in chronic thromboembolic pulmonary disease patients as a function of mean pulmonary artery pressure (mPAP) according to new and previous definitions of pulmonary hypertension | ||
| 520 | |a METHODS: All patients diagnosed with chronic thromboembolic pulmonary disease between January, 2015 and December, 2019 were dichotomized according to initial mPAP: ≤ 20 mmHg ('normal') vs 21-24 mmHg ('mildly-elevated'). Baseline features were compared between the groups, and pairwise analysis performed to determine changes in clinical endpoints at 1-year, excluding those who underwent pulmonary endarterectomy or did not attend follow-up. Mortality was assessed for the whole cohort over the entire study period | ||
| 520 | |a RESULTS: One hundred thirteen patients were included; 57 had mPAP ≤ 20 mmHg and 56 had mPAP 21-24 mmHg. Normal mPAP patients had lower pulmonary vascular resistance (1.6 vs 2.5WU, p < 0.01) and right ventricular end-diastolic pressure (5.9 vs 7.8 mmHg, p < 0.01) at presentation. At 3 years, no major deterioration was seen in either group. No patients were treated with pulmonary artery vasodilators. Eight had undergone pulmonary endarterectomy. Over 37 months median follow-up, mortality was 7.0% in the normal mPAP group and 8.9% in the mildly-elevated mPAP group. Cause of death was malignancy in 62.5% of cases | ||
| 520 | |a CONCLUSIONS: Chronic thromboembolic pulmonary disease patients with mild pulmonary hypertension have statistically higher right ventricular end-diastolic pressure and pulmonary vascular resistance than those with mPAP ≤ 20 mmHg. Baseline characteristics were otherwise similar. Neither group displayed disease progression on non-invasive tests up to 3 years. Mortality over 37 months follow-up is 8%, and mainly attributable to malignancy. Further prospective study is required to validate these findings | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a health outcomes | |
| 650 | 4 | |a pulmonary vascular disease | |
| 650 | 4 | |a thromboembolic disease | |
| 700 | 1 | |a Swietlik, Emilia M |e verfasserin |4 aut | |
| 700 | 1 | |a Robertson, Lucy |e verfasserin |4 aut | |
| 700 | 1 | |a Michael, Alice |e verfasserin |4 aut | |
| 700 | 1 | |a Boyle, Sonja |e verfasserin |4 aut | |
| 700 | 1 | |a Polwarth, Gary |e verfasserin |4 aut | |
| 700 | 1 | |a Screaton, Nick J |e verfasserin |4 aut | |
| 700 | 1 | |a Ruggiero, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Nethercott, Sarah L |e verfasserin |4 aut | |
| 700 | 1 | |a Taboada, Dolores |e verfasserin |4 aut | |
| 700 | 1 | |a Sheares, Karen K |e verfasserin |4 aut | |
| 700 | 1 | |a Hadinnapola, Charaka |e verfasserin |4 aut | |
| 700 | 1 | |a Cannon, John E |e verfasserin |4 aut | |
| 700 | 1 | |a Bunclark, Katherine |e verfasserin |4 aut | |
| 700 | 1 | |a Jenkins, David |e verfasserin |4 aut | |
| 700 | 1 | |a Ng, Choo |e verfasserin |4 aut | |
| 700 | 1 | |a Toshner, Mark R |e verfasserin |4 aut | |
| 700 | 1 | |a Pepke-Zaba, Joanna |e verfasserin |4 aut | |
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