Prognostic factors in severe pulmonary hypertension patients who need parenteral prostanoid therapy: The impact of late referral

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• 作者：Roberto Badagliacca ; MD ; PhD^a ; Beatrice Pezzuto ; MD^a ; Roberto Poscia ; MD ; PhD^a ; Massimo Mancone ; MD ; PhD^a ; Silvia Papa ; MD^a ; Serena Marcon ; MD^a ; Gabriele Valli ; MD^b ; Gennaro Sardella ; MD^a ; Fabio Ferrante ; MD^a ; Carlo Iacoboni ; MD^a ; Daniela Parola ; MD^a ; Francesco Fedele ; MD ; FESC^a ; Carmine Dario Vizza ; MD^a ; ^{dario.vizza@uniroma1.it}
• 关键词：pulmonary arterial hypertension ; prostanoids ; epoprostenol ; treprostinil ; survival
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 出版时间：April, 2012
• 年：2012
• 卷：31
• 期：4
• 页码：364-372
• 全文大小：935 K

文摘

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Background

Oral drugs have made the treatment of pulmonary hypertension (PH) feasible in non-expert centers, which could delay patient access to prostanoid therapy.

Methods

Fifty-seven consecutive patients with precapillary PH received a prostanoid in our center. Data at prostanoid initiation included modality of center referral, medical history, New York Heart Association [NYHA] class, exercise capacity, echocardiographic parameters, and hemodynamics.

Results

Overall survival at 1, 2, and 3 years was 85 % , 69 % , 55 % , respectively. Non-survivors had worse NYHA class III/IV (17/12) than survivors (27/1; p < 0.01) and exercise capacity on 6-minute-walk distance (254 ¡À 114 vs 354 ¡À 91 meters; p < 0.01). Non-survivors were more frequently referred on oral therapy (83 % vs 36 % ; p < 0.01) and had a higher rate of urgent prostanoid treatment (69 % vs 17 % ; p < 0.0001). Multivariate analysis (hazard ratio [95 % confidence interval]) found the independent prognostic factors were urgent prostanoid therapy (2.0 [1.1-3.9]) and NYHA class (3.5 [1.5-8.2]). Survivors had a significant response to prostanoid, improving NYHA class from 2.8 ¡À 0.4 to 2.3 ¡À 0.5 (p = 0.002), 6-minute walk distance from 354 ¡À 91 to 426 ¡À 82 meters (p = 0.0001), and pulmonary hemodynamics (pulmonary artery pressure from 56 ¡À 13 to 44 ¡À 18 mm Hg [p < 0.05]; cardiac index from 2.0 ¡À 1.2 to 3.1 ¡À 1.2 liters/min/m² [p = 0.002], and pulmonary vascular resistance from 17 ¡À 10 to 8 ¡À 6 WU [p = 0.001]).

Conclusions

Referral of patients on oral treatment to a tertiary PH center is delayed and significantly affects prognosis.