Survival in pulmonary hypertension due to chronic lung disease: Influence of low diffusion capacity of the lungs for carbon monoxide.
Aged
Carbon Monoxide
/ metabolism
Chronic Disease
Female
Follow-Up Studies
Forced Expiratory Volume
Humans
Hypertension, Pulmonary
/ etiology
Lung
/ metabolism
Lung Diseases, Interstitial
/ complications
Male
Middle Aged
Minnesota
/ epidemiology
Prognosis
Prospective Studies
Pulmonary Diffusing Capacity
/ physiology
Pulmonary Wedge Pressure
Registries
Risk Assessment
/ methods
Time Factors
Vascular Resistance
/ physiology
COPD
Cor pulmonale
Emphysema
Interstitial lung disease
pulmonary function test
right ventricle
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
01
05
2018
revised:
10
09
2018
accepted:
12
09
2018
pubmed:
6
11
2018
medline:
17
3
2020
entrez:
5
11
2018
Statut:
ppublish
Résumé
Patients with pulmonary hypertension (PH) due to chronic lung disease (Group 3 PH) have poor long-term outcomes. However, predictors of survival in Group 3 PH are not well described. We performed a cohort study of Group 3 PH patients (n = 143; mean age 65 ± 12 years, 52% female) evaluated at the University of Minnesota. The Kaplan-Meier method and Cox regression analysis were used to assess survival and predictors of mortality, respectively. The clinical characteristics and survival were compared in patients categorized by PH severity based on the World Health Organization (WHO) classification and lung disease etiology. After a median follow-up of 1.4 years, there were 69 (48%) deaths. The 1-, 3-, and 5-year survival rates were 79%, 48%, and 31%. Age, coronary artery disease, atrial fibrillation, Charlson comorbidity index, serum N-terminal pro‒brain natriuretic peptide (NT-proBNP), creatinine, diffusion capacity of carbon monoxide (DLCO), total lung capacity, left ventricular ejection fraction, right atrial and right ventricular enlargement on echocardiography, cardiac index, and pulmonary vascular resistance (PVR) were univariate predictors of survival. On multivariable analysis, DLCO was the only predictor of mortality (adjusted hazard ratio [HR] for every 10% decrease in predicted value: 1.31 [95% confidence interval 1.12 to 1.47]; p = 0.003). The 1-/5-year survival by tertiles of DLCO was 84%/56%, 82%/44%, and 63%/14% (p = 0.01), respectively. On receiver-operating characteristic curve analysis, DLCO <32% of predicted had the highest sensitivity and specificity for predicting survival. The 1- and 5-year survival in patients with a DLCO ≥32% predicted was 84% and 60% vs 68% and 13% in patients with a DLCO <32% predicted (adjusted HR: 2.5 [95% confidence interval 1.3 to 5.0]; p = 0.007). Lung volumes and DLCO were not related, but higher PVR was strongly associated with reduced DLCO. There was increased mortality in interstitial lung disease‒PH as compared with chronic obstructive pulmonary disease‒PH, but PH severity based on the WHO classification did not alter survival. Low DLCO is a predictor of mortality and should be used to risk-stratify Group 3 PH patients.
Sections du résumé
BACKGROUND
Patients with pulmonary hypertension (PH) due to chronic lung disease (Group 3 PH) have poor long-term outcomes. However, predictors of survival in Group 3 PH are not well described.
METHODS
We performed a cohort study of Group 3 PH patients (n = 143; mean age 65 ± 12 years, 52% female) evaluated at the University of Minnesota. The Kaplan-Meier method and Cox regression analysis were used to assess survival and predictors of mortality, respectively. The clinical characteristics and survival were compared in patients categorized by PH severity based on the World Health Organization (WHO) classification and lung disease etiology.
RESULTS
After a median follow-up of 1.4 years, there were 69 (48%) deaths. The 1-, 3-, and 5-year survival rates were 79%, 48%, and 31%. Age, coronary artery disease, atrial fibrillation, Charlson comorbidity index, serum N-terminal pro‒brain natriuretic peptide (NT-proBNP), creatinine, diffusion capacity of carbon monoxide (DLCO), total lung capacity, left ventricular ejection fraction, right atrial and right ventricular enlargement on echocardiography, cardiac index, and pulmonary vascular resistance (PVR) were univariate predictors of survival. On multivariable analysis, DLCO was the only predictor of mortality (adjusted hazard ratio [HR] for every 10% decrease in predicted value: 1.31 [95% confidence interval 1.12 to 1.47]; p = 0.003). The 1-/5-year survival by tertiles of DLCO was 84%/56%, 82%/44%, and 63%/14% (p = 0.01), respectively. On receiver-operating characteristic curve analysis, DLCO <32% of predicted had the highest sensitivity and specificity for predicting survival. The 1- and 5-year survival in patients with a DLCO ≥32% predicted was 84% and 60% vs 68% and 13% in patients with a DLCO <32% predicted (adjusted HR: 2.5 [95% confidence interval 1.3 to 5.0]; p = 0.007). Lung volumes and DLCO were not related, but higher PVR was strongly associated with reduced DLCO. There was increased mortality in interstitial lung disease‒PH as compared with chronic obstructive pulmonary disease‒PH, but PH severity based on the WHO classification did not alter survival.
CONCLUSIONS
Low DLCO is a predictor of mortality and should be used to risk-stratify Group 3 PH patients.
Identifiants
pubmed: 30391191
pii: S1053-2498(18)31658-9
doi: 10.1016/j.healun.2018.09.011
pmc: PMC6556403
mid: NIHMS996702
pii:
doi:
Substances chimiques
Carbon Monoxide
7U1EE4V452
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
145-155Subventions
Organisme : NHLBI NIH HHS
ID : F32 HL129554
Pays : United States
Organisme : NHLBI NIH HHS
ID : K08 HL140100
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL113003
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Elsevier Ltd. All rights reserved.
Références
Am J Respir Crit Care Med. 2018 Jun 1;197(11):1496-1499
pubmed: 29360393
J Heart Lung Transplant. 2017 Sep;36(9):957-967
pubmed: 28302503
Chest. 2007 Mar;131(3):650-656
pubmed: 17317730
Chest. 2006 Mar;129(3):746-52
pubmed: 16537877
Chest. 2012 Nov;142(5):1166-1174
pubmed: 22556320
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Cardiovasc Res. 1970 Jan;4(1):23-30
pubmed: 5416840
J Am Soc Echocardiogr. 2010 Jul;23(7):685-713; quiz 786-8
pubmed: 20620859
J Am Coll Cardiol. 2006 Feb 21;47(4):799-803
pubmed: 16487848
Eur Respir J. 2015 Nov;46(5):1247-50
pubmed: 26521275
Pulm Circ. 2015 Jun;5(2):356-63
pubmed: 26064462
PLoS One. 2015 Dec 02;10(12):e0141911
pubmed: 26630396
Eur Respir J. 2015 Nov;46(5):1378-89
pubmed: 26293503
Circulation. 2018 Feb 13;137(7):693-704
pubmed: 29070502
Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e003973
pubmed: 29444925
J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D109-16
pubmed: 24355635
Eur Respir J. 2017 Jan 3;49(1):
pubmed: 28049167
J Heart Lung Transplant. 2012 Apr;31(4):373-80
pubmed: 22226804
Eur Respir J. 2004 Jun;23(6):932-46
pubmed: 15219010
Eur Respir J. 2005 Aug;26(2):319-38
pubmed: 16055882
Pulm Circ. 2016 Dec;6(4):576-585
pubmed: 28090301
JACC Heart Fail. 2016 Jun;4(6):441-9
pubmed: 26874383
J Heart Lung Transplant. 2010 Feb;29(2):181-7
pubmed: 19783169
Respiration. 2013;85(6):456-63
pubmed: 23257350
Circulation. 2010 Jul 13;122(2):164-72
pubmed: 20585012
Respir Med. 2012 Nov;106(11):1613-21
pubmed: 22902266
Pulm Circ. 2017 Mar 24;7(1):145-155
pubmed: 28680574
Am J Respir Crit Care Med. 2017 Dec 1;196(11):1463-1472
pubmed: 29192835
Thorax. 2009 Oct;64(10):883-8
pubmed: 19546096
Respirology. 2011 Apr;16(3):451-8
pubmed: 21122030
Circulation. 2014 Dec 23;130(25):2310-20
pubmed: 25391518
J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14
pubmed: 25559473
Am J Respir Crit Care Med. 2012 Jul 15;186(2):132-9
pubmed: 22538804
Heart. 2012 Dec;98(24):1805-11
pubmed: 22760869