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Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance.

Publication ,  Journal Article
Awerbach, JD; Stackhouse, KA; Lee, J; Dahhan, T; Parikh, KS; Krasuski, RA
Published in: Respir Med
April 2019

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.

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Published In

Respir Med

DOI

EISSN

1532-3064

Publication Date

April 2019

Volume

150

Start / End Page

126 / 130

Location

England

Related Subject Headings

  • Vascular Resistance
  • Tricuspid Valve Insufficiency
  • Survival Analysis
  • Respiratory System
  • Pulmonary Artery
  • Prospective Studies
  • Middle Aged
  • Male
  • Lung Diseases, Obstructive
  • Lung Diseases, Interstitial
 

Citation

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Awerbach, J. D., Stackhouse, K. A., Lee, J., Dahhan, T., Parikh, K. S., & Krasuski, R. A. (2019). Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance. Respir Med, 150, 126–130. https://doi.org/10.1016/j.rmed.2019.03.004
Awerbach, Jordan D., Kathryn A. Stackhouse, Joanne Lee, Talal Dahhan, Kishan S. Parikh, and Richard A. Krasuski. “Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance.Respir Med 150 (April 2019): 126–30. https://doi.org/10.1016/j.rmed.2019.03.004.
Awerbach JD, Stackhouse KA, Lee J, Dahhan T, Parikh KS, Krasuski RA. Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance. Respir Med. 2019 Apr;150:126–30.
Awerbach, Jordan D., et al. “Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance.Respir Med, vol. 150, Apr. 2019, pp. 126–30. Pubmed, doi:10.1016/j.rmed.2019.03.004.
Awerbach JD, Stackhouse KA, Lee J, Dahhan T, Parikh KS, Krasuski RA. Outcomes of lung disease-associated pulmonary hypertension and impact of elevated pulmonary vascular resistance. Respir Med. 2019 Apr;150:126–130.
Journal cover image

Published In

Respir Med

DOI

EISSN

1532-3064

Publication Date

April 2019

Volume

150

Start / End Page

126 / 130

Location

England

Related Subject Headings

  • Vascular Resistance
  • Tricuspid Valve Insufficiency
  • Survival Analysis
  • Respiratory System
  • Pulmonary Artery
  • Prospective Studies
  • Middle Aged
  • Male
  • Lung Diseases, Obstructive
  • Lung Diseases, Interstitial